Newly diagnosed primary hypothyroidism applicant with massive pericardial effusion and acute renal failure

A Case of Profound Hypothyroidism Presenting with Hypertensive Emergency and Large Amount of Pericardial Effusion

Patient: Female, 45-year-old

Final Diagnosis: Hypothyroidism

Symptoms: Dysarthria • dyspnea

Medication:—

Clinical Procedure: Pericardial drainage

Specialty: Cardiology

Untreated primary hypothyroidism with simultaneous rhabdomyolysis, pericardial effusion, and sudden sensorineural hearing loss: a case report

BACKGROUND

Hypothyroidism, one of the prevalent endocrine disorders worldwide, has a broad spectrum of clinical manifestations, from an asymptomatic condition to myxedema coma. Although the majority of patients with hypothyroidism have minor clinical symptoms, which are recovered with levothyroxine treatment, some patients occasionally do experience fatal complications. Here we report, for the first time, the case of a patient who had hypothyroidism with simultaneous occurrence of rhabdomyolysis with acute kidney injury, moderate pericardial effusion, and sudden sensorineural hearing loss.

CASE PRESENTATION

A 57-year-old man with a previous history of dyslipidemia and untreated hypothyroidism was admitted to the hospital due to shortness of breath, lethargy, lower extremity discomfort, and unilateral hearing loss. Laboratory results revealed rhabdomyolysis with acute kidney injury and severe hypothyroidism. We detected cardiomegaly without lung parenchymal infiltration on chest radiography and moderate pericardial effusion on transthoracic echocardiography. We performed pure tone audiometry and identified profound unilateral sensorineural hearing loss. Aggressive fluid resuscitation, levothyroxine treatment, and systemic and intratympanic steroid therapy alleviated the patient's severe hypothyroidism, rhabdomyolysis, and pericardial effusion; however, sensorineural hearing loss was not fully recovered.

CONCLUSIONS

Early recognition of life-threatening complications is important in patients with severe hypothyroidism to prevent adverse outcomes. This case suggests that hypothyroidism should be considered in patients who have rhabdomyolysis with acute kidney disease and pericardial effusion. Moreover, sudden sensorineural hearing loss should be kept in mind as a rare complication of hypothyroidism.

A case of hypertensive emergency, primary hypothyroidism and large pericardial effusion with early tamponade

Thyroid hormones and the cardiovascular system are strongly intertwined with known risk of coronary disease, atrial fibrillation, and cardiomyopathy. Pericardial effusions are commonly seen in cases of severe hypothyroidism, however large to massive pericardial effusions with cardiac tamponade are exceptionally rare. We report a case of a patient presenting with hypertensive emergency and a concomitant diagnosis of primary hypothyroidism with a large pericardial effusion and early echocardiographic features of tamponade. Following pericardiocentesis, hypertension management, and thyroid replacement therapy the patient's symptoms improved with no recurrence of pericardial effusion. <Learning objective: Hypothyroidism is a common medical comorbidity with many clinical manifestations and cardiovascular effects including hypertension. Pericardial effusion is a known complication of hypothyroidism, however cases of massive effusion and tamponade are rare. Management of large effusions is unclear, with some patients treated with thyroid supplement and others requiring pericardiocentesis.>.