Propranolol induced Raynaud phenomenon and facial edema in a patient with Hyperthyroidism: A case report

Background: Propranolol is a non-cardio-selective beta-blocker, commonly used in patients with hyperthyroidism to treat the hyperadrenergic symptoms but also for its additional effect of blocking the peripheral conversion of inactive T4 to active T3. However, propranolol has many side effects, one of them being secondary Raynaud phenomenon. Case presentation: S.K., 55 years old was hospitalized in the Endocrinology Department as an untreated hyperfunctioning goiter with typical clinical manifestations such as fatigue, anxiety, palpitations, heat intolerance, difficulties in swallowing and breathing. Unimazole 5 mg (2-2-2 tb) and Propranolol 40 mg (¼ -0- ¼ tb) were prescribed. Thirty minutes after taking Propranolol (the dose 40 mg), she had difficulties breathing, was agitated, sweating and had nausea. Her face was hyperemic and edematous and her extremities were getting blue and cold. Her vitals remained stable and her airways were opened, as evaluated from laryngoscopy and CT-scan of the neck. 8 hours later, her clinical manifestations got worse: her facial edema spread in her lips and submandibular region. On both cases, she clinically improved after prednisolone administration. 12 hours after taking propranolol, she showed no more signs of cyanosis or edema. Propranolol was replaced by Nebivolol, with no side effects. Conclusion: Secondary Raynaud phenomenon is a common side effect of beta-blockers and should be taken in consideration in very patient presenting with cold and cyanotic peripherals. In these cases, propranolol should be stopped and replaced. Further studies on beta-blockers side effects in patients with hyperthyroidism should be made.