ABSTRACT
Introduction: Non-cardiogenic pleural involvement in hyperthyroidism is rare, with unilateral involvement being rarer still. We present the case of a patient with Graves’ disease (GD) with thyroid storm criteria who presented right pleural effusion compatible with exudate. Case Description: A 40-year-old female patient, with a history of hyperthyroidism for 3 years without treatment for severe rash to thiamazole on two occasions. She was admitted to the emergency room of a private clinic due to dyspnea that progressed to respiratory failure, a massive right pleural effusion was found for which they performed evacuatory thoracentesis, prescribed lugol, bisoprolol and dexamethasone, and she was transferred to our hospital with a total of 45 points on the Burch-Wartofsky’s scale, had respiratory failure and jaundice. The analysis showed: Hemogram: Leukocytes 9700, Hemoglobin: 10.8 g/dl;CRP: 0.43 mg/dl;Glucose 157 mg/dl;Creatinine: 0.29 mg/dl, TSH: < 0.004 uIU/ml, Free T4: > 7.77 ng/ml;Free T3: > 16 pg/ml, Anti-thyroperoxidase: > 1000 IU/ml;Total bilirubins: 5.52 mg/dL;Direct bilirubin: 3.79 mg/dL. COVID infection was ruled out, the analysis of the pleural fluid was compatible with exudate, an echocardiogram showed LVEF: 60% and mild pulmonary hypertension. Thyroid ultrasound revealed diffuse hypervascularized goiter;thyroid scintigraphy showed diffuse hyper-uptake goiter. Dexamethasone with lithium carbonate was indicated with gradual improvement in thyroid function tests and cholestatic pattern. Once compensated she received 20mCi of 131I. She was discharged with an improvement in her symptoms. Her X-ray and her control chest ultrasound did not show the presence of pleural effusion. Discussion: GD is a pathology that presents with a variety of symptoms and signs due to its multisystemic involvement, which can become life-threatening, such as a thyroid storm, if it is not treated properly and in a timely manner. The fact of presenting unilateral massive pleural effusion is a rare presentation of hyperthyroidism reported in other cases.