Ref Number = PITIKA-ASPR0073
Putri Lestari Gabrilasari, Ratna Dewi Artati, Syarifuddin Rauf, St. Aizah Lawang, Besse Sarmila
Background: Graves’ disease is an autoimmune disorder resulting from thyrotropin receptor stimulation by autoantibodies. It may occur during childhood, peaking on adolescence. Hyperthyroidism has systemic effects, and exerts many changes on the cardiovascular system. These effects are related to hemodynamic burden of a hyperdynamic circulation and direct degenerative changes on valve structures leading to heart failure. Autoimmune thyroid disease also can coincide with different forms of glomerular disease. Thyroid dysfunction causes remarkable changes in glomerular functions and water homeostasis leading to nephrotic syndrome. 
Objective: To report a case of graves’ disease with cardiovascular complications and nephrotic syndrome in a thirteen-year and three-month old girl.
Case: A girl, 13-years and 3-months old was admitted with dyspneu since three days before admission. She had swelling all of body and less mixturation since two days before. She was diagnosed with Graves’ disease since one year before and routinely got antithyroid drug. Physical examination presented tachycardia, tachypneu, swelling all of body, coarse crackles on both lung, pansistolic murmur on ictus cordis and decreased urine output. From laboratory findings, there were history of decreased TSH with increased FT4 and Trab when Graves’ disease first diagnosed. There were normositic normochrome anemia; elevated ureum, creatinin and total cholesterol serum; decreased plasma albumin and glomerulus filtration rate; proteinuria and hematuria on urinalysis. On chest xray there was cardiomegaly with pulmonary edema. On echocardiography we got mitral regurgitation, tricuspid regurgitation and pulmonal hypertension. She was treated with oxygen, antithyroid, antibiotic, inotropics, diuretic, antihypertension drugs and corticosteroid.
Conclusion: A case of a thirteen-year and three-month old girl presenting graves’ disease with cardiovascular complications and nephrotic syndrome has been reported. The diagnosis was based on history taking, physical examination and supported laboratory findings. The prognosis was poor.
Keywords: Graves’ Disease, Nephrotic Syndrome, Heart Failure
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