WJCD  Vol.2 No.4 , October 2012
Cardiac tamponade as the initial manifestation of severe hypothyroidism: A case report
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.

Cite this paper
Cohen, R. , Loarte, P. , Opris, S. and Mirrer, B. (2012) Cardiac tamponade as the initial manifestation of severe hypothyroidism: A case report. World Journal of Cardiovascular Diseases, 2, 321-325. doi: 10.4236/wjcd.2012.24051.
References
[1]   Rernam, V.J., Chichgar, J.A., Patkar, L.A., et al. (1983) Myxedema and pericardial effusion with cardiac tamponade (a case report). Journal of Postgraduate Medicine, 29, 188-190.

[2]   Arthur, S., Beeharry-Panray, G., Fitzgerald, J., et al. (2009) Hypothyroidism presenting with recurrent pericardial tamponade. BMJ Case Reports.

[3]   Handler, J. (2007) Hypertensive emergency with cardiac tamponade associated with hypothyroidism. The Journal of Clinical Hypertension, 9, 67-72. doi:10.1111/j.1524-6175.2007.06343.x

[4]   Jimenez-Nacher, J.J., de Alonso, N., Vega, B., et al. (1993) Cardiac tamponade as a presentation of primary hypothyroidism in a young woman. Revista Clínica Espa?ola, 193, 290-292.

[5]   Wang, J.L., Hsieh, M.J., Lee, C.H., et al. (2010) Hypothyroid cardiac tamponade: Clinical features, electrocardiography, pericardial fluid and management. The American Journal of the Medical Sciences, 340, 276-281. doi:10.1097/MAJ.0b013e3181e664c6

[6]   Roy, C.L., Minor, M.A., Brookhart, M.A., et al. (2007) Does this patient with a pericardial effusion have a cardiac tamponade? JAMA, 297, 1810-1818. doi:10.1001/jama.297.16.1810

[7]   Little, W.C. and Freeman, G.L. (2006) Pericardial disease. Circulation, 113, 1622-1632. doi:10.1161/CIRCULATIONAHA.105.561514

[8]   Goswami, R., Tandon, N., Singh, B., et al. (1996) Circulatory collapse in a 30-year-old amenorrheic woman. Post-graduate Medical Journal, 72, 501-509. doi:10.1136/pgmj.72.850.501

[9]   Parving, A., Ostri, B., Bretlau, P., et al. (1979) Mechanisms of edema formation in myxedemaincreased protein extravasation and relatively slow lymphatic drainage. The New England Journal of Medicine, 301, 460-465. doi:10.1056/NEJM197908303010902

[10]   Spodick, D.H. (2003) Acute cardiac tamponade. The New England Journal of Medicine, 349, 684-690. doi:10.1056/NEJMra022643

[11]   Fazio, S., Palmieri, E.A., Lombardi, G. et al. (2004) Effects of thyroid hormone on cardiovascular system. Recent Progress in Hormone Research, 59, 31-50. doi:10.1210/rp.59.1.31

[12]   Dernellis, J. and Panaretou, M. (2002) Effects of thyroid replacement therapy on arterial blood pressure in patients with hypertension and hypothyroidism. American Heart Journal, 143, 718-724. doi:10.1067/mhj.2002.120766

[13]   Foley, C.M., McAllister, R.M. and Hasser, E.M. (2001) Thyroid status influences baroreflex function and auto-nomic contributions to arterial pressure and heart rate. American Journal of Physiology—Heart and Circulatory Physiology, 280, H2061-H2068.

[14]   Wang, J.L., Hsieh, M.J., Lee, C.H., et al. (2010) Hypothyroid cardiac tamponade: Clinical features, electrocardiography, pericardial fluid and management. The American Journal of the Medical Sciences, 340, 276-281. doi:10.1097/MAJ.0b013e3181e664c6

[15]   Glancy, D.L. and Wang, W. (2007) Electrocardiogram in a 55-year-old woman with an endocrinedisorder. Baylor University Medical Center Proceedings, 20, 81-82.

[16]   Maisch, B., Seferovic, P.M., Ristic, A.D., et al. (2004) Guidelines for the diagnosis and management of pericardial diseases. Executive summary. The task force on the diagnosis and management of pericardial diseases of the euro- pean society of cardiology. European Heart Journal, 25, 587-610.

[17]   Hurtado, J.J., Guevara, W., Ramos, E., et al. (2011) Hypothyroidism in a five-year-old boy with rhabdomyolysis and recent history of cardiac tamponade: A case report. Journal of Medical Case Reports, 5, 515-519. doi:10.1186/1752-1947-5-515

[18]   Imazio, M., Spodick, D.H., Brucato, A., et al. (2010) Controversial issues in the management of pericardial dis-eases. Circulation, 121, 916-928. doi:10.1161/CIRCULATIONAHA.108.844753

[19]   Karu, A.K., Khalife, W.I. and Houser, R. (2005) Impend- ing cardiac tamponade as a primary presentation of hypothyroidism: Case report and review of literature. Endocrine Practice, 11, 265-271.

[20]   Vasquez, A. (1993) Cardiac tamponade and hypothyroidism. Intensive Care Medicine, 19, 241. doi:10.1007/BF01694781

[21]   Alsever, R.N., Stjernholm, et al. (1975) Cardiac tamponade in myxedema. The American Journal of the Medical Sciences, 269, 117-121. doi:10.1097/00000441-197501000-00012

[22]   Gumrukcuoglu, H.A., Odabasi, D. and Akdag, S. (2011) Management of cardiac tamponade: A comparative study between echo-guided pericardiocentesis and surgery—A report of 100 patients. Cardiology Reasearch and Practice, 38, p. 7

 
 
Top