SAT506 A Unique Case of Large Pericardial Effusion In Hypothyroidism

Abstract

Abstract Disclosure: M. Ahmad: None. B. Arshad: None. U. Tarabichi: None. A.P. Calimag: None. Introduction: Hypothyroidism if left untreated can have devastating consequences both short and long term. We present you a case in which patient developed large pericardial effusion within a few months of stopping levothyroxine. Pericardial effusion is a relatively infrequent finding in hypothyroidism. This case is unique as large pericardial effusion is typically associated with severe thyroid hormone insufficiency such as myxedema, which wasn’t the case in our patient. Case: Patient is a 46-year-old female with PMHx of papillary thyroid cancer, s/p total thyroidectomy 2008, , HTN, obesity, Vit D Deficiency, iron deficiency anemia, sickle cell trait who presented to the ED with complaints of shortness of breath. Her symptoms started about a week ago and were associated with progressive dyspnea on exertion and fatigue. Patient mentioned that she stopped taking her levothyroxine 188 mcg daily and tried to treat herself with supplements. Workup was relevant for TSH 94.7 (0.350-5.0 mcU/ml), WBC 5.2 (4.2-11.0 k/mcl), Hgb 9.2 (12.0-15.5 g/dl),​ Na 141 (135-145 mmol/L), Cr 1.71 (0.51-0.95 mg/dl), ​negative Troponins,​ NT pro BNP 2590 (less then125 pg/ml)​ D Dimer 1.06. Vitals on presentation to the ED were Bp 194/135, HR 97, RR 18, T 98.4, Spo2 99% on room air.​ Chest x ray revealed new cardiomegaly, mild right sided pleural effusion. CTA chest was negative for pulmonary embolism but showed massive pericardial effusion. This was followed with transthoracic echo which demonstrated the pericardial effusion on the posterior surface of heart without tamponade. Cardiothoracic surgery was consulted but it was decided to treat the patient with IV levothyroxine rather than pericardial drainage as there was no hemodynamic compromise. Patient received 2 doses of IV levothyroxine and followed by PO levothyroxine per home dose. Shortness of breath improved by day 4 and patient was discharge in stable condition. Discussion: Complications related to hypothyroidism are preventable. There is a lot of misleading information about alternative medicine, which in turn can lead to life-threatening complications. Fortunately, pericardial effusion associated with severe hypothyroidism can rarely lead to cardiac tamponade and cardiovascular compromise. More emphasis and counselling about the importance of compliance with levothyroxine can prove vital to prevent thyroid hormone deficiency related complications. Presentation Date: Saturday, June 17, 2023