# A patient with heart failure and coexistence of constrictive pericarditis and Graves’ disease: a case report

## TL;DR

A 47-year-old woman with heart failure and Graves’ disease was found to have a rare condition involving constrictive pericarditis, which improved after surgery.

## Contribution

This is the first reported case of constrictive pericarditis coexisting with Graves’ disease.

## Key findings

- The patient had treatment-resistant right-sided heart failure due to constrictive pericarditis.
- Right heart catheterization confirmed the diagnosis with characteristic pressure patterns.
- Pericardiectomy led to significant improvement in heart failure symptoms.

## Abstract

Thyroid disease is associated with pericarditis. There are several case reports on patients with hyperthyroidism and hypothyroidism complicated by acute pericarditis. However, constrictive pericarditis is a rare complication, particularly in hyperthyroidism, and, to the best of our knowledge, it has not been previously reported.

A 47-year-old female with no past medical, surgical, or radiotherapy history was admitted to our hospital with a diagnosis of congestive heart failure. Although she was treated for heart failure and hyperthyroidism, the right-sided heart failure did not improve. Right heart catheterization revealed elevated mean right atrial pressure and pulmonary artery wedge pressure. The pressure curve of the right ventricle showed a dip and plateau pattern. The end-diastolic pressure in the left and right ventricles was nearly equal. The cause of heart failure was thought to be constrictive pericarditis, and a pericardiectomy was performed. After surgery, the symptoms and findings of heart failure improved dramatically.

We encountered a rare case of heart failure complicated by both constrictive pericarditis and Graves’ disease. Patients with constrictive pericarditis often lack specific laboratory or imaging findings, which can make diagnosis challenging. When treating patients with treatment-resistant right-sided heart failure, it is important to consider constrictive pericarditis and to evaluate haemodynamic evaluation through catheterization.