Abstract
Thyroid dysfunction is a common incidental finding among healthy individuals. It can affect various organs of the body, including the heart. Among many other heart complications, it can lead to pericardial effusion by causing increased permeability of albumin across the pericardial membrane that leads to exudative pericardial effusion. In hypothyroidism, the fluid collection process occurs over a period of months, giving enough time for the pericardial membrane to stretch and accommodate the fluid within itself without causing any symptoms. Eventually, the pericardial membrane stretches to its maximum capacity and has no room to accommodate any more fluid, resulting in cardiac tamponade in the patients. Patients with hypothyroidism-related cardiac tamponade usually remain asymptomatic or present with atypical symptoms such as bradycardia and a normal heart rate or high blood pressure, and the diagnosis comes into light only when patients present to the hospital with hemodynamic instability. In these cases, echocardiography successfully detects large pericardial effusion with collapsed cardiac chambers. To treat hypothyroidism-related cardiac tamponade, treating the underlying condition has been very successful in the majority of the asymptomatic patients, but pericardiocentesis is required in emergencies to relieve symptoms of patients presenting with hemodynamic instability.We believe hypothyroidism-related cardiac tamponade is a preventable condition if detected and treated in outpatient settings by family physicians. This will prevent occurrence of various complications arising from hypothyroidism, including pericardial effusion. This will lead to a better quality of life among patients with the added benefit of reduced health care burden due to reduced frequency of hospital admissions of acutely ill patients.
Highlights
BackgroundIt is suggested that about 4% to 10% of the general population is affected by hypothyroidism [1]
Patients with hypothyroidism-related cardiac tamponade usually remain asymptomatic or present with atypical symptoms such as bradycardia and a normal heart rate or high blood pressure, and the diagnosis comes into light only when patients present to the hospital with hemodynamic instability
To treat hypothyroidismrelated cardiac tamponade, treating the underlying condition has been very successful in the majority of the asymptomatic patients, but pericardiocentesis is required in emergencies to relieve symptoms of patients presenting with hemodynamic instability
Summary
It is suggested that about 4% to 10% of the general population is affected by hypothyroidism [1]. Hypothyroidism associated pericardial effusion can vary from being asymptomatic to presenting as cardiac tamponade, in which patients present with hemodynamic compromise [11]. The severity of the pericardial effusion depends on the speed of fluid accumulation in the pericardial sac If it is getting collected over a short period, such as after trauma, the clinical presentation would be dramatic, i.e., even small amounts of blood over a short period can cause high pressure inside the pericardial cavity-causing hemodynamic instability in the patients. Since the right atrium is thin-walled, it is the most vulnerable to compression by the pericardial fluid, but its increased pressure affects the veno-atrial gradient that determines the cardiac filling [13] This causes a hemodynamic compromise in the body, creating a shock-like state in the body. Alexander first described this in 1919, as the pericardial effusion of "gold-paint" appearance due to the presence of cholesterol in the fluid with no bacteria in it [19]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
