6772 Graves' Wrath on the Heart: A Focus on Pericardial Effusion

Abstract Disclosure: R. Subramani: None. S. Zahra: None. F. Manas: None. Introduction: Hyperthyroidism, marked by an overproduction of thyroid hormones, is linked to various cardiovascular issues like high or normal output heart failure, arrhythmias, and tachycardia-related cardiomyopathy. Pericardial effusion is less common in hyperthyroidism compared to hypothyroidism. Here we report a 20 year old with pericardial effusion, later diagnosed with Grave’s disease. Case Summary: A 20-year-old female with a past medical history of anxiety, depression, and seizure disorder presented to the emergency department with chief complaints of dizziness, shortness of breath, palpitations, and chest pain. She complained of tremors, generalized weakness, and weight loss for the last two months. She denied any personal or family history of hypo- or hyper-thyroidism. No history of head or neck irradiation, anterior neck tenderness or pain, dysphagia or hoarseness. No history of recent viral infection. Examination revealed tachycardia with thyromegaly and pericardial friction rub but there was no neck tenderness, exophthalmos or lid lag. Blood work was remarkable for low TSH (<0.02 uIu/ml, normal: 0.27-4.2 uIu/ml) and elevated free T4 (>7.7nd/dl, normal:0.9-1.7ng/dl) and total T3 (>651 ng/dl, normal 80-200 ng/dl). Rest of the blood work, including blood cultures and immunologic workup (antinuclear antibody, anti-neutrophil cytoplasmic antibody, and rheumatoid factor) was negative. EKG showed sinus tachycardia. CT chest confirmed thyromegaly and showed pericardial effusion. Ultrasound neck showed enlarged heterogeneous thyroid gland with relative increased vascularity. Echocardiography showed mild to moderate pericardial effusion with no tamponade physiology and normal ejection fraction. Anti thyroid peroxidase antibodies, thyroid stimulating immunoglobulin, and TSH receptor antibodies were markedly elevated. The patient was diagnosed with Grave’s thyrotoxicosis with thyromegaly and pericardial effusion. Endocrinology was consulted and the patient was started on beta blockers for symptom control and anti-thyroid medication (methimazole). Discussion: Fabowale MO et al highlighted the potential role of immunological mechanisms in causing pericardial effusion, while Fonseca et al focused on pathophysiological changes involving both extravascular and intravascular proteins, coupled with reduced lymphatic drainage. Cardiac complications in Graves' disease tend to occur more frequently when the condition has been poorly managed for an extended period before seeking medical help. If symptoms persist despite achieving proper control, clinicians need to be watchful for potential cardiac complications. Presentation: 6/3/2024