Early Cardiac Tamponade in a Patient with Postsurgical Hypothyroidism.

Archana Sinha,Sri Lakshmi Hyndavi Yeruva,Rajan Kumar,Bryan H Curry

doi:10.1155/2015/310350

Archana Sinha, Sri Lakshmi Hyndavi Yeruva + Show 2 more

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https://doi.org/10.1155/2015/310350

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Abstract

Pericardial effusion is a common cardiac manifestation of hypothyroidism, but effusion resulting in cardiac tamponade is extremely rare. We present a case of a 56-year-old African American woman with slurred speech and altered mental status that was initially suspected to have stroke. Her chest X-ray revealed cardiomegaly and subsequent echocardiogram showed a large pericardial effusion with echocardiographic evidence of cardiac tamponade. Clinically, patient did not have pulsus paradoxus or hypotension. Further questioning revealed a history of total surgical thyroidectomy and noncompliance with thyroid replacement therapy. Pericardiocentesis was performed promptly and thyroxine replacement therapy was started. Thereafter, her mental status improved significantly. The management of pericardial effusion associated with hypothyroidism varies depending on size of effusion and hemodynamic stability of the patient. The management strategy ranges from conservative management with close monitoring and thyroxine replacement to pericardiocentesis or creation of a pericardial window.

Highlights

Pericardial effusion may be caused by acute pericarditis, tumor, uremia, hypothyroidism, trauma, cardiac surgery, or other inflammatory conditions
We report here a case of early cardiac tamponade, due to untreated postsurgical hypothyroidism
Our patient did not present with typical symptoms of clinical tamponade and severe hypothyroidism posing clinical dilemma

Summary

Introduction

Pericardial effusion may be caused by acute pericarditis, tumor, uremia, hypothyroidism, trauma, cardiac surgery, or other inflammatory conditions. Pericardial effusion is a known complication of hypothyroidism with the incidence ranging from 3–6% in mild cases of hypothyroidism to 30%−80% in severe hypothyroidism [1]. Cardiac tamponade secondary to hypothyroidism is rare as the fluid accumulates slowly, allowing for pericardial sac distension [2]. Even a small pericardial effusion can cause clinically significant tamponade, if it accumulates rapidly. It is important to suspect tamponade when patients have hemodynamic compromise regardless of the amount of pericardial effusion present. We report here a case of early cardiac tamponade, due to untreated postsurgical hypothyroidism

Case Report

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