Abstract
Background: Hypothyroidism is a commonly seen condition. The presence of pericardial effusion with cardiac tamponade as initial manifestation of this endocrinological condition is very unusual. Objectives: In hypothyroidism pericardial fluid accu-mulates slowly, allowing adaptation and stretching of the pericardial sac, sometimes accommodating a large volume. Case Report: A 39 year-old female presented with chest pain, dyspnea and lower extremity edema for 1 day. Bradycardia, muffled heart sounds and severe hypertension were noticed. Chest radiograph showed an enlarged cardiac silhouette. A bedside echocardiogram revealed a cardiac tamponade, later she developed sudden hypotension and bradycardia that resolved after pericardiocentesis of 1 liter of pericardial fluid. The further laboratory evaluation revealed a TSH value of 69.3 miU/L and low T3 and free T4. The patient later developed reaccumulation of pericardial fluid with the need for creation of pericardial window. Conclusion: When the classic Beck’s triad is not present and bradycardia accompanies a cardiac tamponade, hypothyroidism should be strongly suspected. The requirement for thyroid hormone supplement is critical and is well reported. There is a chance of recurrence even after starting levothyroxine supplementation; and the associated hypertension usually requires treatment with more than one drug.
Highlights
Pericardial effusion due to hypothyroidism was reported as early as 1918 and subsequently in 1925 [1]
Hypothyroidism is characterized by low metabolic demands and despite a depressed cardiac contractility and cardiac output, cardiac function remains sufficient to sustain the workload imposed on the heart
Another feature that distinguishes cardiac tamponade caused by hypothyroidism from the other causes of tamponade is the absence of sinus tachycardia as a mechanism to maintain cardiac output [5]
Summary
Pericardial effusion due to hypothyroidism was reported as early as 1918 and subsequently in 1925 [1]. Until 1992, there were less than 30 cases described and even more recently there are only few cases found in the world literature This low incidence is most likely due to slow accumulation of fluid and gradual pericardial distention [4]. Hypothyroidism is characterized by low metabolic demands and despite a depressed cardiac contractility and cardiac output, cardiac function remains sufficient to sustain the workload imposed on the heart. We report a case of cardiac tamponade as a presenting manifestation of hypothyroidism. The presence of pericardial effusion with cardiac tamponade as initial manifestation of this endocrinological condition is very unusual. A bedside echocardiogram revealed a cardiac tamponade, later she developed sudden hypotension and bradycardia that resolved after pericardiocentesis of 1 liter of pericardial fluid. There is a chance of recurrence even after starting levothyroxine supplementation; and the associated hypertension usually requires treatment with more than one drug
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