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

Abstract

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