Pericardial decompression syndrome in a patient with hypothyroidism presenting as massive pericardial effusion: a case report and review of related literature

Lim, Aveline Sue Ann Lim; Paz-Pacheco, Elizabeth; Reyes, Michael; Punzalan, Felix Eduardo R.

doi:10.1136/bcr.04.2011.4117

Cited by 15 publications

(10 citation statements)

References 29 publications

(48 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…First, pericardial diseases occur in autoimmune and non-autoimmune hypothyroidism alike: they have been reported in autoimmune thyroiditis,5 10 as well as in hypothyroidism due to iodine deficiency30 and postsurgical hypothyroidism 31. Second, to date, no specific antibodies have been proven to be the culprit of pericardial diseases in hypothyroidism 5 29.…”

Section: Pathophysiologymentioning

confidence: 99%

Pericardial diseases in patients with hypothyroidism

Chahine

Chandra

Gentry

et al. 2019

Heart

View full text Add to dashboard Cite

Hypothyroidism is a well-known cause of pericardial effusion (with an incidence of 3%–37%) and can cause cardiac tamponade in severe cases. In this review, we present the current knowledge on the epidemiology of hypothyroid-induced pericardial diseases, the mechanism through which low thyroid hormone levels affect the pericardium, the associated clinical manifestations, diagnostic tests and management options. Hypothyroidism causes pericardial effusion through increased permeability of the epicardial vessels and decreased lymphatic drainage of albumin, resulting in accumulation of fluid in the pericardial space. Interestingly, autoimmunity does not seem to play a major role in the pathophysiology, and a majority of effusions are asymptomatic due to slow fluid accumulation. The diagnosis is generally made when the pericardial disease is associated with an elevated thyroid-stimulating hormone level, and other secondary causes are excluded. Management consists of thyroid replacement therapy, along with pericardial drainage in case of tamponade.In conclusion, hypothyroidism-induced pericardial diseases are underdiagnosed. Initiating treatment early in the disease process and preventing complications relies on early diagnosis through systematic screening per guidelines.

show abstract

Section: Pathophysiologymentioning

confidence: 99%

Pericardial diseases in patients with hypothyroidism

Chahine

Chandra

Gentry

et al. 2019

Heart

View full text Add to dashboard Cite

show abstract

“…Patient's hemodynamic status was continuously monitored, during and after the pericardiocentesis. Lim et al have shown association of fatal postprocedural “pericardial decompression syndrome” with pericardiocentesis [ 3 ]. Three liters of hazy, yellowish/“gold paint” pericardial fluid was drained ( Figure 4 ).…”

Section: Case Reportmentioning

confidence: 99%

Early Cardiac Tamponade in a Patient with Postsurgical Hypothyroidism

Sinha

Yeruva

Kumar

et al. 2015

Case Reports in Cardiology

View full text Add to dashboard Cite

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.

show abstract

“…Pericardial effusion and even cardiac tamponade as presenting symptoms of hypothyroidism are rare but have been described earlier [ 12 – 16 ]. In the general population, the risk of major complications after pericardiocentesis is reported to be about 5% [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, it was reported that the cardiovascular system is significantly depressed as the response to catecholamines might be significantly reduced by downregulated expression of adrenergic receptors in hypothyroidism [ 19 ]. Lim et al described a pericardial decompression syndrome, which resulted in severe hemodynamic instability after diagnostic needle pericardiocentesis in a patient with hypothyroidism [ 16 ]. Therefore, the body cannot counteract the hemodynamic effects of a cardiac tamponade with tachycardia and peripheral vasoconstriction [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Intracerebral Bleeding and Massive Pericardial Effusion as Presenting Symptoms of Myxedema Crisis

Kirsch

Rimpau

Nickel

et al. 2017

Case Reports in Emergency Medicine

View full text Add to dashboard Cite

The endocrinological emergency of a fully blown myxedema crisis can present as a multicolored clinical picture. This can obscure the underlying pathology and easily lead to mistakes in clinical diagnosis, work-up, and treatment. We present a case of an unconscious 39-year-old patient with a medical history of weakness, lethargy, and findings of hyponatremia, intracerebral bleeding, and massive pericardial effusion. Finally, myxedema crisis was diagnosed as underlying cause. Replacement therapy of thyroid hormone and conservative management of the intracerebral bleeding resulted in patient's survival without significant neurological impairment. However, diagnostic pericardiocentesis resulted in life-threatening pericardial tamponade. It is of tremendous importance to diagnose myxoedema crisis early to avoid adverse health outcomes.

show abstract

Pericardial decompression syndrome in a patient with hypothyroidism presenting as massive pericardial effusion: a case report and review of related literature

Cited by 15 publications

References 29 publications

Pericardial diseases in patients with hypothyroidism

Pericardial diseases in patients with hypothyroidism

Early Cardiac Tamponade in a Patient with Postsurgical Hypothyroidism

Intracerebral Bleeding and Massive Pericardial Effusion as Presenting Symptoms of Myxedema Crisis

Contact Info

Product

Resources

About