Postpartum Thyroiditis Complicated by Peripartum Cardiomyopathy and Right Ventricular Thrombi: A Case Report from Rural Uganda

Mughanda Mugheni Olive,1 Kusemererwa Byaruhanga,1 Nsimire Mulanga Roseline,1 Thomas Kwesiga,1 Ernest Badako Mogonza,1 Bigabwa Baharanyi Dominique,1 Venance Emmanuel Mswelo,1 Hildah Kirabo Nlumansi,1 Charles Malisaba Posite2,3 1Department of Internal Medicine, Kampala International University, Kampala, Uganda; 2Department of Pathology, Kampala International University, Kampala, Uganda; 3Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the CongoCorrespondence: Mughanda Mugheni Olive, Department of Internal Medicine, Kampala International University, Kampala, Uganda, Email [email protected]: Postpartum thyroiditis (PPT) and peripartum cardiomyopathy (PPCM) are important postpartum conditions, but their coexistence is rare. Thyrotoxicosis can increase myocardial stress and precipitate heart failure, particularly in resource-limited settings where diagnosis may be delayed.Case Presentation: A 30-year-old woman presented two months postpartum with thyrotoxic symptoms and was diagnosed with postpartum thyroiditis. Poor adherence to therapy led to progressive dyspnea and edema. Six months postpartum, she re-presented with decompensated heart failure. Chest X-ray showed cardiomegaly. Echocardiography revealed a dilated left ventricle (LVEDD 6.7 cm, LVESD 5.9 cm) with severely reduced systolic function (LVEF ~23%). The right ventricle was dilated with preserved function (TAPSE 1.7 cm). Mild pulmonary hypertension (RVSP 36 mmHg) and multiple right ventricular apical thrombi (n=3) were identified. She was diagnosed with peripartum cardiomyopathy and treated with guideline-directed heart failure therapy, anticoagulation, bromocriptine, and antithyroid medication, with significant clinical improvement.Conclusion: This case highlights the importance of early echocardiography, integrated endocrine–cardiac evaluation, and close postpartum follow-up in women presenting with unexplained dyspnea.Keywords: hyperthyroidism, heart failure, cardiomyopathy, ventricular thrombi, postpartum, rural Uganda