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Dilated cardiomyopathy with Graves disease in a young child
Yu Jung Choi1, Jun Ho Jang1, So Hyun Park1
1Department of Pediatrics, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.
Insights
Graves disease (GD) rarely causes dilated cardiomyopathy (DCMP) in children. This case shows a young boy with GD-induced DCMP who recovered with treatment, demonstrating potential for cardiac function improvement.
Area of Science:
- Pediatric Endocrinology
- Cardiology
- Internal Medicine
Background:
- Graves disease (GD), a common cause of hyperthyroidism, can lead to serious cardiac complications.
- Dilated cardiomyopathy (DCMP) is a recognized complication of GD in adults but is exceptionally rare in pediatric populations.
- Early diagnosis and management are crucial for preventing severe cardiac dysfunction in children with GD.
Purpose of the Study:
- To report a rare case of dilated cardiomyopathy (DCMP) in a young child secondary to Graves disease (GD).
- To highlight the diagnostic challenges and therapeutic strategies for pediatric GD-induced DCMP.
- To emphasize the potential for cardiac recovery with appropriate medical management.
Main Methods:
- Case presentation of a 32-month-old boy with symptoms of hyperthyroidism and heart failure.
- Diagnostic workup included physical examination, chest radiography, echocardiography, and thyroid function tests (TFTs).
- Treatment involved methylprednisolone, diuretics, inotropics, and methimazole, with regular monitoring of cardiac function and TFTs.
Main Results:
- The patient presented with tachycardia, goiter, hepatomegaly, cardiomegaly, and pulmonary edema, alongside significantly reduced ejection fraction (28%).
- Elevated serum T3, decreased TSH, and high TSH receptor antibody titers confirmed GD; TFT normalization correlated with improved EF.
- Despite a recurrence of hyperthyroidism due to poor compliance, the patient showed no relapse of DCMP, maintaining normal cardiac function.
Conclusions:
- Graves disease can induce dilated cardiomyopathy even in very young children, presenting a diagnostic and therapeutic challenge.
- Prompt medical management targeting both hyperthyroidism and heart failure can lead to complete recovery of cardiac function.
- This case underscores the importance of vigilant cardiac monitoring in pediatric patients with Graves disease and the potential for favorable outcomes.
Abstract:
Graves disease (GD) can lead to complications such as cardiac arrhythmia and heart failure. Although dilated cardiomyopathy (DCMP) has been occasionally reported in adults with GD, it is rare in children. We present the case of a 32-month-old boy with DCMP due to GD. He presented with irritability, vomiting, and diarrhea. He also had a history of weight loss over the past few months. On physical examination, he had tachycardia without fever, a mild diffuse goiter, and hepatomegaly. The chest radiograph showed cardiomegaly with pulmonary edema, while the echocardiography revealed a dilated left ventricle with an ejection fraction (EF) of 28%. The thyroid function test (TFT) showed elevated serum T3 and decreased thyroid stimulating hormone (TSH) levels. The TSH receptor autoantibody titer was elevated. He was diagnosed with DCMP with GD; treatment with methylprednisolone, diuretics, inotropics, and methimazole was initiated. The EF improved after the TFT normalized. At follow-up several months later, although the TFT results again showed evidence of hyperthyroidism, his EF had not deteriorated. His cardiac function continues to remain normal 1.5 months after treatment was started, although he still has elevated T3 and high TSH receptor antibody titer levels due to poor compliance with drug therapy. To summarize, we report a young child with GD-induced DCMP who recovered completely with medical therapy and, even though the hyperthyroidism recurred several months later, there was no relapse of the DCMP.
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