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Prosthetic mitral valve thrombosis associated with new-onset hyperthyroidism due to Graves' disease: a case report
Hasan Hadzalic1, Selma Hasific2, Luca Oechslin1
1Heart Clinic Zurich, Hirslanden Hospital, Witellikerstrasse 40, 8032 Zurich, Switzerland.
Insights
New-onset hyperthyroidism can cause bioprosthetic valve thrombosis, a rare complication. Prompt treatment of hyperthyroidism and anticoagulation resolved the thrombosis and restored valve function in a patient.
Area of Science:
- Cardiology
- Endocrinology
- Thrombosis Research
Background:
- Graves' disease is associated with cardiovascular complications.
- The link between new-onset hyperthyroidism and bioprosthetic valve thrombosis is not well-documented.
- Bioprosthetic valve thrombosis poses a significant risk of thromboembolic events.
Observation:
- A 59-year-old male presented with new-onset hyperthyroidism six years post-bioprosthetic mitral valve replacement.
- Echocardiography indicated valve failure due to thrombosis, presenting with high transmitral gradients.
- Clinical presentation mimicked endocarditis, necessitating urgent evaluation.
Findings:
- Hyperthyroidism creates a pro-thrombotic and hypofibrinolytic state, increasing thrombosis risk.
- The patient's valve thrombosis resolved with thyreostatic therapy and anticoagulation.
- Restored thyroid function normalized valve function and eliminated thrombus.
Implications:
- Hyperthyroidism should be considered in the differential diagnosis of new-onset valvular thrombosis.
- An interdisciplinary approach is crucial for managing hyperthyroidism-induced valve thrombosis.
- Early diagnosis and treatment are vital for favorable outcomes in such cases.
Background:
Graves' disease is linked to a range of cardiovascular diseases. However, the association of new-onset hyperthyroidism with bioprosthetic valve thrombosis has not been reported yet.
Case Summary:
We present the case of a 59-year-old Caucasian male who developed new-onset overt hyperthyroidism 6 years after undergoing bioprosthetic mitral valve replacement. Echocardiography revealed valve failure with high transmitral gradients caused by valve thrombosis. Following appropriate thyreostatic treatment and anticoagulation, his symptoms resolved, and subsequent evaluations showed resolution of the thrombus and normal valve function.
Conclusion:
In this case, the association of new-onset hyperthyroidism with bioprosthetic valve thrombosis is highly likely. Hyperthyroidism, characterized by a hypercoagulable state and hypofibrinolytic disorder, is known to be associated with thrombosis and thromboembolic events. As acute hyperthyroidism shows clinical features similar to endocarditis, an interdisciplinary approach, immediate appropriate diagnostic steps and management are crucial for a favourable outcome. This case suggests that hyperthyroidism should be considered in the differential diagnosis when evaluating new-onset valvular thrombosis.
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