Pericardial diseases in patients with hypothyroidism

Abstract

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.

Pharmacotherapeutic Management Strategies for Thyroid Disease–Induced Pericarditis

“…12 Patients may present with nonspecific symptoms such as syncope, weakness, shortness of breath, lower-extremity edema, and/or gastrointestinal (GI) symptoms. 12 Although cardiac tamponade is relatively uncommon in patients with pericarditis secondary to hypothyroidism, a pericardial effusion will be present in upward of approximately 40% of patients. 12 Pericardial effusions in hypothyroidism can be relatively large, especially in patients who present with myxedema coma.…”

“…12 Although cardiac tamponade is relatively uncommon in patients with pericarditis secondary to hypothyroidism, a pericardial effusion will be present in upward of approximately 40% of patients. 12 Pericardial effusions in hypothyroidism can be relatively large, especially in patients who present with myxedema coma. 12 In patients who do not present with tamponade physiology, they will often present with bradycardia and a relatively high thyroid stimulating hormone (TSH) level.…”

A Case Report of Hypothyroidism and Pericardial Effusion

“…Without cardiac tamponade, cardiovascular examination is normal except in those cases in which there are large volumes of effusion. Heart sounds might become muffled and it may be difficult to palpate the apex pulse[5] [7][8]. In the reported case, despite the effusion's volume was estimated to be more than 1000 cc, cardiovascular physical examination did not provide relevant data.…”

Hypothyroidism Causing Pericardial Effusion: A Case Report

“…Hypothyroidism, having the potential to affect any organ system, can be complicated by serious pathologies requiring timely intervention. One of the rare, yet serious complications of hypothyroidism is pericardial effusion [5][6][7][8][9][10]. Hypothyroidism causes increased permeability of the pericardial capillaries to albumin.This, in addition to decreased drainage of albumin into the lymphatic system, leads to increased colloid pressure within the pericardium and hence, decreased colloid osmotic pressure gradient between the pericardial space and pericardium.…”