Myocardial Dysfunction in Hypothyroid Children

Farooki, Zia Q.; Hoffman, William H.; Perry, Burton L.; Green, Edward W.

doi:10.1001/archpedi.1983.02140270055018

Cited by 15 publications

(13 citation statements)

References 19 publications

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“…Pericardial effusion is often associated with infection, but it also occurs in rheumatic fever, uraemia and myxoedematous hypothyroidism [3,4,6,7]. Its incidence in Down syndrome has not been systematically studied.…”

Section: Discussionmentioning

confidence: 99%

Pericardial effusion as a sign of acquired hypothyroidism in children with Down syndrome

et al. 1993

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In three children with Down syndrome and acquired hypothyroidism echocardiography was performed before and after the start of L-thyroxine treatment. Initial studies revealed pericardial effusions which resolved during treatment suggesting that they were caused by hypothyroidism. The incidence of hypothyroidism in Down syndrome is high, but the diagnosis is often missed for lack of specific clinical criteria. The finding of pericardial effusion by echocardiography may be essential in discovering thyroid dysfunction. The cases illustrate that regular thyroid function tests are important in Down syndrome.

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Section: Discussionmentioning

confidence: 99%

Pericardial effusion as a sign of acquired hypothyroidism in children with Down syndrome

et al. 1993

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“…Pericardial effusion has long been known to be a feature of so-called myxedema heart [3]. However, it was the use of echocardiography that established the presence of not previously suspected lesions, indicated by such characteristics as thickening of the interventricular septum [9] and other abnormalities of cardiac muscle [12][13][14][15][16][17][18]. In our study, a wide variety of lesions were found in hypothyroid patients (Tables 1-3).…”

Section: Discussionmentioning

confidence: 54%

“…Echocardiographic demonstration of pericardial effusion in adult patients with hypothyroidism has ranged from about 30% [11] to 80% [10]. Two studies on hypothyroid children reported similar frequencies of about 73% [13,14]. There have been case reports of pericardial tamponade in hypothyroidism [19,20], although it is considered rare.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, there have been several publications on the echocardiographic findings in adults with hypothyroid [10,12], as well as children [13,14] and even neonates [15] with the condition. However, some of these studies had a relatively small number of patients [10,12], relied only on M-mode echocardiography [10,11], or focused primarily on pericardial effusion [9][10][11].…”

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confidence: 99%

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The Spectrum of Echocardiographic Abnormalities in Hypothyroidism and the Effect of Hormonal Treatment

et al. 1991

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Cross-sectional echocardiography was used to identify and quantify different cardiac abnormalities in 85 patients with hypothyroidism. Pericardial effusion was the most common and was found in 32 patients (37.6%), while abnormal increase in left ventricular dimensions with impairment of function followed next in frequency (16.4%). Asymmetrical septal hypertrophy as well as segmental wall motion abnormality were each detected in 11.76%. Holosystolic prolapse of the mitral valve was present in only 4.7% of the cases. Different combinations of abnormalities were observed in a total of 22 patients (25.76%), and pericardial effusion was a constant finding. Some of the abnormalities were reversed with physiological thyroxin replacement, but abnormal regional abnormal wall motion remained unimproved. The notion that the heart could be affected in hypothyroidism is at least a hundred years old, but the concept of a myxedema heart was first proposed by Zondek [1] in 1918. This concept was further advanced by Fahr [2] and Kern et al [3] in their clinical studies. Kern et al attributed most of the cardiac features of hypothyroidism to the presence of pericardial effusion, namely: clinical cardiomegaly, distant heart sounds, radiological enlargement of the heart, and low-voltage QRS complex on the electrocardiogram. For a long time thereafter, there was disagreement as to whether all the findings in myxedema heart were due to pericardial effusion or there was an associated intrinsic cardiac muscle abnormality, i.e., a cardiomyopathy. Early autopsy studies indicated the existence of structural abnormalities in the myocardium [4,5].Hemodynamic techniques [6] and noninvasive methods such as systolic time intervals [7] were subsequently used to demonstrate depressed myocardial contractility with reduced stroke volume and low cardiac output in untreated hypothyroidism. Kerber and Sherman [8] were perhaps the first to systematically use echocardiography to demonstrate pericardial effusion in hypothyroidism, while Santos et al [9] first used this method to draw attention to other types of cardiac abnormality, such as asymmetrical septal thickening.Subsequently, there have been several publications on the echocardiographic findings in adults with hypothyroid [10,12], as well as children [13,14] and even neonates [15] with the condition. However, some of these studies had a relatively small number of patients [10,12], relied only on M-mode echocardiography [10,11], or focused primarily on pericardial effusion [9][10][11].In the present report, which we believe is the first such study in an Arab population, both M-mode and twodimensional echocardiography were used to evaluate a large number of hypothyroid patients for the purpose of establishing not only the spectrum of abnormalities in the pericardium, myocardium, and valvular apparatus, but also the effect of hormonal treatment on the detected abnormalities.

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“…In fact, few and inconsistent data are reported on the prevalence of pericardial effusion in children, particularly in infants with congenital hypothy roidism (CH). Two different groups reported an elevated prevalence of pericardial effusion in children [5,6] but it is noteworthy that both groups referred to nonhomogeneous populations with respect to etiology (thyroiditis, thyroidectomy, CH) and to the age of diagnosis (from a few months to 16 years). Therefore, it has not been pos sible to determine exactly the time lapse of hormonal deficiency.…”

Section: Introductionmentioning

confidence: 99%

Congenital Hypothyroidism and Pericardial Effusion

et al. 1991

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A group of infants, affected by congenital hypothyroidism diagnosed through the neonatal screening program, was investigated with echocardiography to detect the presence of pericardial effusion. We studied the relationship between the effusion and the etiology of hypothyroidism, established through thyroid scintiscanning. Our data show a high prevalence of effusion in hypothyroid patients, without other clinical signs of cardiac involvement as well as a relationship between the etiology of hypothyroidism and the presence of effusion. This seems to be much more frequent in those forms which can imply a more severe hormonal defect, particularly during fetal life (agenesis/dyshormonogenesis). Furthermore, the high prevalence of pericardial effusion suggests to start the L-T₄ replacement therapy with lower dosages as commonly advised, in order to avoid a cardiac involvement.

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Myocardial Dysfunction in Hypothyroid Children

Cited by 15 publications

References 19 publications

Pericardial effusion as a sign of acquired hypothyroidism in children with Down syndrome

Pericardial effusion as a sign of acquired hypothyroidism in children with Down syndrome

The Spectrum of Echocardiographic Abnormalities in Hypothyroidism and the Effect of Hormonal Treatment

Congenital Hypothyroidism and Pericardial Effusion

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