Pericardial Effusion with Cardiac Tamponade as a Form of Presentation of Primary Hypothyroidism

Abstract

The authors describe a case of pericardial effusion accompanied by cardiac tamponade caused by primary hypothyroidism. Diagnosis was made by exclusion, because other causes of cardiac tamponade are more frequent. Emergency treatment of cardiac tamponade is pericardiocentesis (with possible pericardial window), and, after stabilization, performance of hormonal reposition therapy with L-thyroxin

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

“…Subxiphoid pericardiostomy to address cardiac tamponade is usually successful 17 26 27. In our hospital, it carries with it very low morbidity 1–2% and mortality <1%,5 that is comparable to other centers 29.…”

“…Unlike other causes of cardiac tamponade, the following considerations should be made during treatment: First, cardiomyopathy or ischemic heart disease may be concomitantly present due to hypothyroidism-induced changes in the cardiac myocytes and a predisposition to an atherogenic profile (increased total cholesterol and low-density cholesterol), thereby increasing cardiovascular risk respectively; Second, hypothyroidism is characterised by lowered metabolic demands, and that despite a decrease in cardiac output in the presence of tamponade, cardiac function may remain sufficient to sustain the demands imposed on the heart16; Lastly, given the rarity of hypothyroidism-induced tamponade, other precipitating factors such as infection, spontaneous haemorrhage, thyroid treatment or abdominal paracentesis,17 should be considered during investigation 10 17…”

“…Although there is evidence that starting levothyroxine replacement at 100 mcg/day outright may be tolerated,12 18 in most cases it is recommended to start at a lower dose of 25–50 mcg per day with gradual uptitration,12 15 17 19 20 especially in cases wherein an underlying heart disease cannot be ruled out. This is to prevent the possibility of precipitating cardiac ischemia, as well as new effusions, or decompensation towards cardiac tamponade 17 20. Onset of resolution often precedes achievement of euthyroidism and ranges up to 1–21 months 6 11.…”

Cardiac Tamponade: Rare presentation of Hypothyroidism

“…With smaller cardiac chambers, the myocardial diastolic compliance is reduced and cardiac inflow becomes limited, ultimately equalizing mean diastolic pericardial and chamber pressures. This equalization of pressures is the hallmark of cardiac tamponade [9].…”

Cardiac Tamponade in a Patient with Primary Hypothyroidism

“…Pericardial effusion is one of the cardiac manifestations in myxedema. 1 Cardiac tamponade is usually a consequence of increased pericardial pressure with accumulation of fluid in the pericardial space. Cardiac tamponade as a complication of hypothyroidism is very rare.…”