Pericarditis as the Presenting Feature of Graves Disease in a Pediatric Patient

Abstract

Pericarditis is a rare presentation of thyrotoxicosis associated with Graves disease. This association has not been previously described in the pediatric literature. We report a 17-year-old male patient who presented with chest pain, dyspnea, and tachycardia. He was found to have diffuse ST-segment elevation consistent with pericarditis. At presentation, he was noted to have bilateral proptosis. Abnormal thyroid function studies and an elevated thyroid-stimulating hormone receptor antibody level confirmed the diagnosis of Graves thyrotoxicosis. The patient was treated with anti-inflammatory and antithyroid agents and improved in time. We discuss previously reported cases of Graves disease-associated pericarditis in adults, potential etiologies, and management strategies.

Right Heart Failure and Hyperthyroidism: A Neglected Association

“…In contrast with hypothyroidism, pericardial effusion remains a rare complication of hyperthyroidism, which is common with Grave disease [12]. It is mainly caused by an autoimmune mechanism [13].…”

Pleuropericardial Compromise Associated With Graves’ Disease: A Systematic Review

“…One study was excluded because it was a case of hyperthyroidism without a specific cause mentioned [38]. Fourteen studies, including 15 patients in total, were included in the qualitative review (Table 1) [7,[39][40][41][42][43][44][45][46][47][48][49][50][51]. In addition, we registered the diagnostic features of PPC (Table 2) [7,[39][40][41][42][43][44][45][46][47][48][49][50][51].…”

“…One study reached a perfect score (six points). The experience of the investigator and the follow-up were the sections with more missing information (Table 3) [7,[39][40][41][42][43][44][45][46][47][48][49][50][51]. A total of 13 cases reported follow-up data (four of them reported 6 months or more).…”

“…Fourteen studies, including 15 patients in total (Table 1) [7,[39][40][41][42][43][44][45][46][47][48][49][50][51] were included in the qualitative review, being cases of serositis associated with GD [7,[39][40][41][42][43][44][45][46][47][48][49][50][51]. The mean age of the patients in the studies was 47.2 ± 18.7 years at the time of diagnosis.…”

“…In addition, six patients were female [7,42,44,48,49], accounting for 40% of the sample. Regarding clinical features that implied immunological features, orbitopathy was present in two patients [39,45] and goiter in eight [39,40,[42][43][44][46][47][48]; dermopathy was not detected in any of the patients.…”