A Case Report On Congestive Cardiac Failure Due To Hyperthyroidism

A 51-year-old married woman referred to Nigerian Air Force hospital Kaduna from a local hospital in Kebbi, Kebbi State, Nigeria because of persistent epigastric pain that lasted several weeks. The pain was resistant to any anti acids or proton pump inhibitors. In addition, she complained of hand shaking, feeling excessive bodily heat, breathlessness on exertion, recurrent diarrhoea and loss of weight despite having a very good appetite. On arrival, the patient was comfortable and in no acute distress. Her vital signs other than the rapid irregularly pulse rate, were within normal limits. Her Jugular venous pulsation was slightly elevated, and her carotid upstroke was normal, and no carotid bruits were appreciated. However, a symmetrically enlarged, nontender thyroid gland was palpable, with a bruit over the left lobe. Mild stare and lid lag were noticed, along with mild tremor of the outstretched hands. Chest examination revealed no abnormalities. The abdomen was mildly tender, and the liver palpable 2 cm below the costal margin. A slight pitting ankle oedema was noted bilaterally. The results of routing laboratory investigations were unremarkable except for the abnormal thyroid function tests (TFT’s) which was consistent with hyperthyroidism. The ECG revealed atrial fibrillation with a left ventricular hypertrophy. An initial diagnosis of atrial fibrillation and congestive heart failure (CHF) secondary to thyrotoxicosis was made. The patient was placed on intravenous furosemide, oral digoxin and angiotensin-converting enzyme (ACE) inhibitors. She was also placed on carbimazole 20 mg daily and atenolol 100 mg daily. Within the next 5 days her ECG spontaneously converted to sinus rhythm, and her TFTs markedly improved. Key Words: Atrial Fibrillation; Congestive Cardiac Failure; Sinus Rhythm; Furosimide; Carbimazole