Pregnancy Complicated by Thyroid Heart Disease: a Case Report

Abstract

Hyperthyroidism is known to give effect on cardiovascular system such as arrhythmias, vascular changes, widened pulse pressure, and myocardial remodeling. It can also affect pregnancy by harming both maternal and fetal condition. Uncontrolled thyrotoxicosis can increase the risk of complication such as preeclampsia, maternal congestive heart failure, pregnancy loss, prematurity, low birth weight, stillbirth, and IUGR. A 35 years old pregnant women presented with dyspnea since a year ago and progressively worsened since her 3^rd month of pregnancy. Other symptoms were swollen legs, palpitations, thyroid enlargement, and sweating.  The patient’s blood pressure was 140/50 mmHg and heart rate was 97 bpm. On physical examination, a mid-systolic scratching sound was heard over the upper part of the sternum or second left intercostal space at the end of expiration, which is called The Means–Lerman scratch that occurs in patients with hyperthyroidism. This patient Wayne’s Index was 24. Chest x-ray showed a pulmonary edema and cardiomegaly. An echocardiography revealed normal LV systolic function (EF by teich 65%), abnormal LV diastolic function grade 3, and mild concentric left ventricle hypertrophy. Laboratory results showed TSHs, FT3, and FT4 were 0.17 uIU/mL, 35.7 Pmol/L, and >100.00 Pmol/L. This patient was diagnosed with G3P2 gestational age 22-23 weeks and thyroid heart disease with heart failure preserved ejection fraction. This patient was given furosemide, propanolol, and propylthiouracil. After the symptoms subside, furosemide was discontinued. The therapy was given with monitoring of fetal heart rate and an improvement was seen throughout the hospitalization.