Cardiac tamponade as the initial manifestation of severe hypothyroidism: A case report

Ronny Cohen, Pablo Loarte, Simona Opris, Brooks Mirrer

Division of Cardiology, Woodhull Medical Center, New York, USA.
Division of Nephrology and Hypertension, Brookdale University Hospital and Medical Center, New York, USA.
NYU School of Medicine, New York, USA.

DOI: 10.4236/wjcd.2012.24051                

Abstract

Background: Hypothyroidism is a commonly seen condition. The presence of pericardial effusion with cardiac tamponade as initial manifestation of this endocrinological condition is very unusual. Objectives: In hypothyroidism pericardial fluid accu-mulates slowly, allowing adaptation and stretching of the pericardial sac, sometimes accommodating a large volume. Case Report: A 39 year-old female presented with chest pain, dyspnea and lower extremity edema for 1 day. Bradycardia, muffled heart sounds and severe hypertension were noticed. Chest radiograph showed an enlarged cardiac silhouette. A bedside echocardiogram revealed a cardiac tamponade, later she developed sudden hypotension and bradycardia that resolved after pericardiocentesis of 1 liter of pericardial fluid. The further laboratory evaluation revealed a TSH value of 69.3 miU/L and low T3 and free T4. The patient later developed reaccumulation of pericardial fluid with the need for creation of pericardial window. Conclusion: When the classic Beck’s triad is not present and bradycardia accompanies a cardiac tamponade, hypothyroidism should be strongly suspected. The requirement for thyroid hormone supplement is critical and is well reported. There is a chance of recurrence even after starting levothyroxine supplementation; and the associated hypertension usually requires treatment with more than one drug.

Keywords

Cardiology; Cardiac Tamponade; Pericardial Effusion; Hypothyroidism; Emergency Department; Pericardiocentesis; Thyroid

Conflicts of Interest

The authors declare no conflicts of interest.

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