Endocrine Abstracts

Introduction: Graves’ disease is the commonest cause of thyrotoxicosis. If left untreated myriad of complications, chief among which are cardiac related morbidity and mortality might supervene.

Case presentation: A 31-year-old man presented to the endocrine clinic of LAUTECH Teaching Hospital, Ogbomoso, Nigeria 19 months ago with features suggestive of hyperthyroidism and a diagnosis of thyrotoxicosis secondary to Graves’ disease was made. He was commenced on carbimazole and propranolol tablets. He has defaulted follow-up care until 14 months later when he presented at the emergency unit with a 10 month history of progressive bilateral swelling of the legs and 2 week history of worsening dyspnoea accompanied by other features of congestive heart failure; and tell tail signs of unabated thyrotoxicosis. He has not been compliant with carbimazole. On examination he was conscious but in respiratory distress and afebrile with temperature of 36.4°C. Other findings include: chemosis, exolphthalmos, lid lag, goitre and bilateral pitting pedal oedema. Cardiovascular system examination revealed a pulse of 108/min regular and of normal volume. His blood pressure was 160/100 mmHg, has distended neck veins, apex beat was not displaced and heart sounds were S1S2S3 and no murmurs. Significant findings in other systems included a right pleural effusion and ascites. He was stabilized on supplemental oxygen, intravenous lasix; carbimazole and propranolol were recommenced. Antimicrosomal antibody titre was 615.65 IU\ml (reference range is 0–35). His latest TFTs results of 13/05/2016: free T3-18.83 pmol/l (reference range is 3.1–6.8) free T4-22.03 pmol/l (reference range is 12–22), and TSH-0.005 uUI/ml (reference range is 0.270–4.20). He is presently out of failure and has been continued on carbimazole to await definitive treatment once euthyroid.

Conclusion: Graves’disease can be complicated by congestive heart failure which is reversible with the use of antithyroid drugs, and diuretics at the acute phase.