Postpartum Thyroiditis Complicated by Peripartum Cardiomyopathy and Right Ventricular Thrombi: A Case Report from...

Postpartum thyroiditis (PPT) and peripartum cardiomyopathy (PPCM) are important postpartum conditions, but their coexistence is rare. Thyrotoxicosis can increase myocardial stress and precipitate heart failure, particularly in resource-limited settings where diagnosis may be delayed.

A 30-year-old woman presented two months postpartum with thyrotoxic symptoms and was diagnosed with postpartum thyroiditis. Poor adherence to therapy led to progressive dyspnea and edema. Six months postpartum, she re-presented with decompensated heart failure. Chest X-ray showed cardiomegaly. Echocardiography revealed a dilated left ventricle (LVEDD 6.7 cm, LVESD 5.9 cm) with severely reduced systolic function (LVEF ~23%). The right ventricle was dilated with preserved function (TAPSE 1.7 cm). Mild pulmonary hypertension (RVSP 36 mmHg) and multiple right ventricular apical thrombi (n=3) were identified. She was diagnosed with peripartum cardiomyopathy and treated with guideline-directed heart failure therapy, anticoagulation, bromocriptine, and antithyroid medication, with significant clinical improvement.

This case highlights the importance of early echocardiography, integrated endocrine-cardiac evaluation, and close postpartum follow-up in women presenting with unexplained dyspnea.