Pericardial Effusion in Severe Hypothyroidism in Children

Abstract

Pleural and pericardial effusion is a rare complication of severe hypothyroidism in children but can be present in 10 to 30 % of adults. Most pediatric cases have been in children with Down syndrome. In this report, six cases of pericardial effusion in children with severe hypothyroidism with and without trisomy 21 are presented. In all patients, the pericardial effusion was managed successfully without pericardiocentesis. The effusions resolved completely in 2 to 12 months after initiation of thyroxin replacement. In conclusion, hypothyroidism should be considered in any child with unexplained pericardial or pleural effusions. Early recognition and treatment with thyroid hormone replacement could eliminate the need for unnecessary diagnostic procedures and invasive treatment measures and reduce the risk of progression to cardiac tamponade. KEY WORDSpericardial effusion, hypothyroidism

Pericardial effusion associated with hypothyroidism in an adult female with down syndrome

“…Echocardiographic studies on children have shown that individuals with Down syndrome have a significantly higher prevalence of isolated pericardial effusions compared to controls [Concolino et al, 2005]. So far the association of pericardial effusion and hypothyroidism has repeatedly been reported in children [Martinez-Soto et al, 2010;Anah et al, 2011] but as yet only in two cases of male adults with Down syndrome [Said et al, 2007;Toorians and van Ekelen, 2007]. So far the association of pericardial effusion and hypothyroidism has repeatedly been reported in children [Martinez-Soto et al, 2010;Anah et al, 2011] but as yet only in two cases of male adults with Down syndrome [Said et al, 2007;Toorians and van Ekelen, 2007].…”

“…However, it is still unclear whether the high prevalence of pericardial effusions in patients with Down syndrome is caused by hypothyroidism or if it should be considered an isolated finding. Pericardial effusions associated with hypothyroidism resolved after treatment with levothyroxine [Said et al, 2007;Toorians and van Ekelen, 2007;Martinez-Soto et al, 2010]. Pericardial effusions associated with hypothyroidism resolved after treatment with levothyroxine [Said et al, 2007;Toorians and van Ekelen, 2007;Martinez-Soto et al, 2010].…”

“…In the general population hypothyroidism can be complicated by pericardial effusion [Kabadi and Kumar, 1990;Hardy et al, 2004]. So far the association of pericardial effusion and hypothyroidism has repeatedly been reported in children [Martinez-Soto et al, 2010;Anah et al, 2011] but as yet only in two cases of male adults with Down syndrome [Said et al, 2007;Toorians and van Ekelen, 2007]. However, it is still unclear whether the high prevalence of pericardial effusions in patients with Down syndrome is caused by hypothyroidism or if it should be considered an isolated finding.…”

“…So far the association of pericardial effusion and hypothyroidism has repeatedly been reported in children [Martinez-Soto et al, 2010;Anah et al, 2011] but as yet only in two cases of male adults with Down syndrome [Said et al, 2007;Toorians and van Ekelen, 2007]. Pericardial effusions associated with hypothyroidism resolved after treatment with levothyroxine [Said et al, 2007;Toorians and van Ekelen, 2007;Martinez-Soto et al, 2010]. Evidence on the relationship between the two clinical conditions is still lacking in adults, especially in females with Down syndrome.A 43-year-old woman presented to the emergency room with a new onset of unspecific, breathing dependent chest pain and left sided shoulder pain, which had first occurred the night before.…”

Structure and Function of the Circulatory System in Hypothyroid Patients

“…While pleural or pericardial effusions are noted in 10% to 30% of the adult hypothyroidism patients, this complication is rare in children (Martinez-Soto et al, 2010). The main symptoms of cardiac tamponade in hypothyroid patients are increased or normal heart rate (after pericardiocentesis, the tempo is slowed) distant heart sounds, enlarged jugular veins, low P valves, T valves and QRS complex in the electrocardiogram and massive pericardial effusion in echocardiography.…”