ECEESPE2025 ePoster Presentations Thyroid (198 abstracts)
Severe graves’ disease presenting with supraventricular tachycardia (SVT) in a 54-year-old male smoker
Muhammad Haroon Riasat 1 , Samraiz Nafees 1 , Khaled Zamari 2 , Shahzad Akbar 3 , Ali Javeed 1 , Adi Ahmed 1 , Sarath Vayolipoyil 1 , Khush Bakht 3 , Muhammad Adnan Afzal 3 , Arshad Jamil 4 & Ali Hassan 5
1York and Scarborough Teaching Hospitals NHS Trust, Scarborough, United Kingdom; 2Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom; 3Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom; 4Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom; 5Manchester University NHS Foundation Trust, Manchester, United Kingdom
JOINT3637
Background: Graves’ disease is an autoimmune disorder characterized by hyperthyroidism, which can lead to various cardiovascular complications. This case report describes a 54-year-old Caucasian male smoker who presented with chest pain and subsequent collapse, leading to the diagnosis of severe Graves’ disease complicated by supraventricular tachycardia (SVT).
Case Presentation: A 54-year-old Caucasian male, typically fit and an avid cyclist but a significant smoker, presented to the Emergency Department with a 6-week history of chest pain, followed by a collapse. Initial ECG revealed a heart rate of 200 bpm, diagnosed with SVT. The patient was resuscitated, stabilized with adenosine, and started on rate control medication. Physical examination revealed severe thyrotoxicosis, evidenced by tremors, sweating, and palpitations, without signs of orbitopathy. Blood investigations confirmed severe Graves’ disease with fully suppressed TSH (<0.01 mU/l), elevated T3 (39 pmol/l) and T4 (92 pmol/l), and TRAB levels of 15.9 U/l. Additional findings included mild anaemia, raised ALP, and hypercalcemia, likely secondary to thyrotoxicosis.
Management and Outcome: The patient was initiated on Carbimazole 40 mg once daily and counselled about potential side effects. Beta-blockers, previously started as prophylaxis for SVT, were continued with advised titration. Clinical improvement was observed on high-dose Carbimazole, with repeat thyroid function tests showing a reduction in free T4 to 30 pmol/l. The patient was informed about the high risk of relapse due to elevated TRAB antibodies, and future radioactive iodine (RAI) therapy was discussed.
Conclusion: This case highlights the importance of considering thyroid dysfunction in patients presenting with cardiac arrhythmias, especially in the presence of risk factors such as smoking. The rapid diagnosis and management of both the cardiac and thyroid components were crucial in stabilizing the patient. Regular follow-up and consideration of definitive treatment options, such as RAI, are essential in managing severe Graves’ disease to prevent recurrence and complications. Smoking may exacerbate Graves’ disease and increase cardiovascular risk. SVT can be an initial presentation of severe thyrotoxicosis. This case exemplifies the necessity for a multidisciplinary approach in managing complex endocrine-cardiac presentations and emphasizes the importance of thorough patient education and ongoing monitoring to achieve optimal outcomes.
Volume 110
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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