Pharmacotherapeutic Management Strategies for Thyroid Disease–Induced Pericarditis

Abstract

Objective: To describe the various pharmacotherapeutic strategies in managing thyroid disease-induced pericarditis (TDIP). Considerations for both hypothyroid-induced and hyperthyroid-induced pericarditis will be discussed. Data Sources: A literature search of MEDLINE, including PubMed, was performed inclusive of all years, using the following search terms: thyroid disease, pericardial diseases, pericarditis, acute pericarditis, cholesterol pericarditis, hypothyroidism, hyperthyroidism, colchicine, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, methimazole, propylthiouracil, and P-glycoprotein. Product monographs were reviewed as well. Study Selection and Data Extraction: Relevant English-language studies and data as well as the most current guidelines for diagnosis and management of thyroid and pericardial diseases were considered. Because of limited data regarding the subject matter, no date range limits were established during literature search. Data Synthesis: It is well documented that thyroid dysfunction can adversely affect cardiovascular function. Additionally, there are published guidelines on the diagnosis and management of pericarditis and, separately, thyroid disease. There are limited data, however, on managing TDIP. The sequela of untreated TDIP can be detrimental. Relevance to Patient Care and Clinical Practice: Strategies on managing TDIP are scarcely reported in the literature. This review provides clinicians with a single reference source for treatment strategies toward managing hypothyroidism-induced and hyperthyroidism-induced pericarditis as well as significant drug interactions that can potentially confound the management of hypothyroidism- and hyperthyroidism-induced pericarditis. Conclusions: Treatment of TDIP involves addressing both the thyroid disease as well as the pericarditis. Along with treatment strategies, clinicians should also consider potential drug-drug and drug-disease interactions that can potentially worsen clinical outcomes.

Myopericarditis and thyroiditis: a case report

“…There is also evidence to suggest an autoimmune aetiology of both thyroiditis and myopericarditis, in particular Graves’ disease. 8 Fatourechi and Edwards 9 evaluated endomyocardial biopsy samples from 11 patients with Graves’ disease and unexplained low-output cardiac failure and found that two had lymphocytic infiltrates suggestive of an autoimmune myocarditis. A further theory is that thyroid hormones may lead to a change in myocardial fat metabolism, 10 although this is more commonly described in hypothyroidism.…”

“…Furthermore, satisfactory treatment of the underlying hyperthyroidism seems crucial in the effective resolution of pericarditis. 8 Continuation of Colchicine to cover the period until thyroid hormones have normalized should be considered. 8 …”

“… 8 Continuation of Colchicine to cover the period until thyroid hormones have normalized should be considered. 8 …”

Pericarditis. Clinical Guidelines 2022

“…Рекомендации по лечению гидроперикарда у пациентов с гипотиреозом основываются на данных клинических наблюдений, рандомизированные клинические исследования в этом направлении не проводились. Есть данные об эффективности применения АСК** и НПВП, #Безвременника осеннего семян экстракта, ГКС [27,226]. Однако необходимо учитывать, что дисфункция щитовидной железы может оказывать влияние не только на сердечно-сосу-дистую систему, но и на метаболизм лекарственных препаратов, их фармакокинетику и фармакодинамику, повышать риск лекарственных взаимодействий.…”

“…Известно, что некоторые НПВП могут оказывать влияние на уровень тиреоидных гормонов, затрудняя оценку эффективности заместительной терапии. Вместе с тем, по данным клинических наблюдений, подобное действие не выявлено при использовании #индометацина и #ибупрофена** [226].…”