1
|
Maddali VR, Miryala S, Bellamkonda YS, Nagula P. Cardiac tamponade due to primary hypothyroidism: acute management and approach to prevent recurrence-a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32617463 PMCID: PMC7319808 DOI: 10.1093/ehjcr/ytaa071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/01/2019] [Accepted: 03/12/2020] [Indexed: 11/13/2022]
Abstract
Background Hypothyroidism is a common endocrine disorder resulting from deficiency of thyroid hormone, with iodine deficiency remains the foremost cause. It is more common in women with increasing incidence in the elderly. The manifestations of hypothyroidism results from the hypometabolism in the body at cellular level and affects all organs. Although there can be an incidental diagnosis of the disorder, the presentation with cardiac signs and symptoms is rare. We report a case of primary hypothyroidism with dysmorphic features manifesting as massive pericardial effusion with cardiac tamponade at presentation. Case summary A female aged 20 years presented with lethargy, constipation, and dyspnoea of 6 months duration. On examination, she was short-statured and had dysmorphic features with hypotension, raised jugular venous pressure (JVP), muffled heart sounds, and thyroid stimulating hormone >100 uIU/mL. Chest X-ray showed cardiomegaly and 2DEcho confirmed cardiac tamponade for which emergency pericardiocentesis was done. Discussion Cardiovascular manifestations in hypothyroidism are dyspnoea and decreased exercise tolerance. Bradycardia, diastolic hypertension, cardiomegaly, and non-pitting or pitting peripheral oedema may be seen on physical examination. Mild pericardial effusion is common and generally asymptomatic. Massive pericardial effusion being manifested at presentation primarily as a sign of hypothyroidism is rare. A few cases have been mentioned in the literature in India and western population. Rarely, hypothyroidism presents with massive pericardial effusion resulting in cardiac tamponade as in our case.
Collapse
Affiliation(s)
- Vikas Reddy Maddali
- Department of Cardiology, Osmania General Hospital, Hyderabad, Telangana, India
| | - Srikar Miryala
- Department of Cardiology, Osmania General Hospital, Hyderabad, Telangana, India
| | | | - Praveen Nagula
- Department of Cardiology, Osmania General Hospital, Hyderabad, Telangana, India
| |
Collapse
|
2
|
Intracerebral Bleeding and Massive Pericardial Effusion as Presenting Symptoms of Myxedema Crisis. Case Rep Emerg Med 2017; 2017:8512147. [PMID: 28255471 PMCID: PMC5309401 DOI: 10.1155/2017/8512147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/05/2016] [Accepted: 12/26/2016] [Indexed: 11/18/2022] Open
Abstract
The endocrinological emergency of a fully blown myxedema crisis can present as a multicolored clinical picture. This can obscure the underlying pathology and easily lead to mistakes in clinical diagnosis, work-up, and treatment. We present a case of an unconscious 39-year-old patient with a medical history of weakness, lethargy, and findings of hyponatremia, intracerebral bleeding, and massive pericardial effusion. Finally, myxedema crisis was diagnosed as underlying cause. Replacement therapy of thyroid hormone and conservative management of the intracerebral bleeding resulted in patient's survival without significant neurological impairment. However, diagnostic pericardiocentesis resulted in life-threatening pericardial tamponade. It is of tremendous importance to diagnose myxoedema crisis early to avoid adverse health outcomes.
Collapse
|
3
|
Early Cardiac Tamponade in a Patient with Postsurgical Hypothyroidism. Case Rep Cardiol 2015; 2015:310350. [PMID: 26294982 PMCID: PMC4534597 DOI: 10.1155/2015/310350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/21/2015] [Indexed: 11/17/2022] Open
Abstract
Pericardial effusion is a common cardiac manifestation of hypothyroidism, but effusion resulting in cardiac tamponade is extremely rare. We present a case of a 56-year-old African American woman with slurred speech and altered mental status that was initially suspected to have stroke. Her chest X-ray revealed cardiomegaly and subsequent echocardiogram showed a large pericardial effusion with echocardiographic evidence of cardiac tamponade. Clinically, patient did not have pulsus paradoxus or hypotension. Further questioning revealed a history of total surgical thyroidectomy and noncompliance with thyroid replacement therapy. Pericardiocentesis was performed promptly and thyroxine replacement therapy was started. Thereafter, her mental status improved significantly. The management of pericardial effusion associated with hypothyroidism varies depending on size of effusion and hemodynamic stability of the patient. The management strategy ranges from conservative management with close monitoring and thyroxine replacement to pericardiocentesis or creation of a pericardial window.
Collapse
|
4
|
Chaudhari SS, Wankhedkar KP, Mushiyev S. SLE or hypothyroidism: who can triumph in cardiac tamponade? CASE REPORTS 2015; 2015:bcr-2014-206095. [DOI: 10.1136/bcr-2014-206095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
5
|
Purkait R, Prasad A, Bhadra R, Basu A. Massive pericardial effusion as the only manifestation of primary hypothyroidism. J Cardiovasc Dis Res 2014; 4:248-50. [PMID: 24653591 DOI: 10.1016/j.jcdr.2014.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/12/2014] [Indexed: 11/19/2022] Open
Abstract
Small pericardial effusion (PE) is not an infrequent manifestation in primary hypothyroidism. But massive PE with or without cardiac tamponade is rare and often associated with severe form of the disease. Here we report an eight-year-old boy who was admitted with massive PE that required repeated pericardiocentesis. Detailed examinations failed to identify the etiology initially. Five months later, child was readmitted with massive PE with impending cardiac tamponade. Primary hypothyroidism was diagnosed based on the clinical and laboratory finding and was thought to be the underlying etiology of previously encountered undiagnosed massive PE. Beside pericardiocentesis, child was treated with thyroid hormone replacement. Condition gradually improved without further recurrence of PE till date. Therefore, irrespective of the presence of clinical signs, primary hypothyroidism should be suspected in every patient presenting with massive PE to prevent recurrence as well as its serious complications like cardiac tamponade.
Collapse
Affiliation(s)
- Radheshyam Purkait
- Department of Paediatric Medicine, NRS Medical College and Hospital, Kolkata 700014, West Bengal, India
| | - Anand Prasad
- Department of Paediatric Medicine, NRS Medical College and Hospital, Kolkata 700014, West Bengal, India
| | - Ramchandra Bhadra
- Department of Radiology, NRS Medical College and Hospital, Kolkata 700014, West Bengal, India
| | - Arindam Basu
- Department of Cardiology, NRS Medical College and Hospital, Kolkata 700014, West Bengal, India
| |
Collapse
|
6
|
Butala A, Chaudhari S, Sacerdote A. Cardiac tamponade as a presenting manifestation of severe hypothyroidism. BMJ Case Rep 2013; 2013:bcr-12-2011-5281. [PMID: 23389717 DOI: 10.1136/bcr-12-2011-5281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a patient who presented to our hospital with unusual symptoms of non-specific complaints and uncontrolled hypertension. Acute cardiac tamponade was suspected from cardiomegaly on routine chest x-ray and confirmed with an echocardiogram. Analysis of the pericardial fluid and other laboratory data ruled out all the common causes except for hypothyroidism as a cause of cardiac tamponade. Tamponade results from increased intrapericardial pressure caused by the accumulation of pericardial fluid. The rapidity of fluid accumulation is a greater factor in the development of tamponade than absolute volume of the effusion. Hypothyroidism is a well-known cause of pericardial effusion. However, tamponade rarely develops owing to a slow rate of accumulation of pericardial fluid. The treatment of hypothyroidic cardiac tamponade is different from other conditions. Thyroxine supplementation is all that is necessary. Rarely, pericardiocentesis is needed in a severely symptomatic patient.
Collapse
Affiliation(s)
- Ashvin Butala
- Department of Medicine, Woodhull Medical Center, Brooklyn, New York, USA
| | | | | |
Collapse
|
7
|
Thirone ACP, Danieli RV, Ribeiro VMFC. [Massive pericardial effusion as initial manifestation of hypothyroidism]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2012; 56:383-7. [PMID: 22990643 DOI: 10.1590/s0004-27302012000600007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 07/22/2012] [Indexed: 11/22/2022]
Abstract
The aim of this study is to report a rare case of massive pericardial effusion as initial manifestation of hypothyroidism. A previously healthy 21-year-old female patient suddenly began presenting dyspnea at rest and lower limb edema. Routine laboratory tests performed at admission showed hypothyroidism (TSH 146.14 mUI/L) and echocardiography showed significant pericardial effusion. Therapy was instituted with levothyroxine, resulting in clinical improvement without pericardiocentesis. The patient was followed up for 1 year, with total remission of dyspnea and edema. However, she developed typical symptoms of hypothyroidism, and remained with asthenia, dyslipidemia, weight gain, and mild pericardial effusion at the end of one year, even with the optimization of the levothyroxine dose. This case highlights the need for early investigation of hypothyroidism in patients with pericardial effusion.
Collapse
|
8
|
Hypothyroidism in the elderly: Diagnostic pitfalls illustrated by a case report. Arch Gerontol Geriatr 2012; 55:82-4. [DOI: 10.1016/j.archger.2011.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 04/27/2011] [Accepted: 05/01/2011] [Indexed: 11/18/2022]
|
9
|
Lim ASAL, Paz-Pacheco E, Reyes M, Punzalan F. Pericardial decompression syndrome in a patient with hypothyroidism presenting as massive pericardial effusion: a case report and review of related literature. BMJ Case Rep 2011; 2011:bcr0420114117. [PMID: 22679149 PMCID: PMC3189646 DOI: 10.1136/bcr.04.2011.4117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The authors present a case of a 44-year-old female with unrecognised hypothyroidism consulting for heart failure symptoms. Echocardiogram revealed massive pericardial effusion with tamponade physiology, attributed to primary hypothyroidism from a previous thyroidectomy. Levothyroxine was started at a dose of 0.7 ug/kg/day followed by subxiphoid pericardiostomy. 9 h postpericardiostomy however, hypotension developed and despite hydration and inotropic support, patient succumbed to cardiogenic shock on the 14th hospital day.
Collapse
Affiliation(s)
- Aveline Sue Ann Lim Lim
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, UP-Philippine General Hospital, Manila, Philippines.
| | | | | | | |
Collapse
|
10
|
Hypothyroid cardiac tamponade: clinical features, electrocardiography, pericardial fluid and management. Am J Med Sci 2010; 340:276-81. [PMID: 20601858 DOI: 10.1097/maj.0b013e3181e664c6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiac tamponade associated with hypothyroidism has been reported, but few studies address the clinical features. This study aims to identify the patient characteristics and to propose a reasonable clinical approach for hypothyroid cardiac tamponade. METHOD Patients admitted to Chang Gung Memorial Hospital between September 1998 and September 2008 with pericardial effusion secondary to hypothyroidism were enrolled. Cases involving cardiac tamponade were investigated. The clinical data, electrocardiography, echocardiography and aspirated fluid were examined. RESULTS Thirty-six patients with moderate or large amount of pericardial effusion as a result of hypothyroidism were examined. Eight patients (22.2%) with both clinical and echocardiographic signs of tamponade were identified and were treated by pericardiocentesis or creation of pleural-pericardial window. These patients were characterized with normal sinus rhythm (80.75 ± 13.45 beats/min), low voltage over limb leads (6 of 8, 75.0%), flat T wave (6 of 8, 75.0%) and clear yellowish pericardial fluid (7 of 8, 87.5%). Their heart rates were significantly lower (80.75 ± 13.45 beats/min versus 112.75 ± 12.87 beats/min, P < 0.01) than those of patients with cardiac tamponade from malignancy, autoimmune disease, tuberculosis and iatrogenic insult. Their interventricular septa were also significantly thicker (15.71 ± 6.70 mm versus 11.70 ± 2.11 mm, P = 0.02). Ten patients (27.8%) had echocardiographic signs of tamponade without paradoxical pulse and were successfully treated with thyroxine without pericardial drainage. CONCLUSION For patients diagnosed with cardiac tamponade without sinus tachycardia, hypothyroidism should be highly suspected. Although emergent pericardiocentesis should be performed in clinical cardiac tamponade, patients with echocardiographic tamponade signs without a paradoxical pulse should be treated with thyroxine initially.
Collapse
|
11
|
Nagrani T, Neuman T, Baldari D, Zaher M, Lafferty J, Baglini R, Kasabian A. Tamponade following breast augmentation. Ann Plast Surg 2010; 64:141-3. [PMID: 20098095 DOI: 10.1097/sap.0b013e3181b0bb1f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Breast augmentation is one of most commonly performed cosmetic surgical procedures. Pneumothorax has been reported as a rare complication of breast augmentation but the incidence is not known. Our patient presented with dyspnea on exertion about 6 days following breast augmentation. She was found to have cardiac tamponade and pneumothorax. We present a case of cardiac tamponade following breast augmentation, a previously unreported complication.
Collapse
Affiliation(s)
- Tarun Nagrani
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, USA.
| | | | | | | | | | | | | |
Collapse
|
12
|
Arthur S, Beeharry-Panray G, Fitzgerald J, Loke I. Hypothyroidism presenting with recurrent pericardial tamponade. BMJ Case Rep 2009; 2009:bcr03.2009.1674. [PMID: 22132022 DOI: 10.1136/bcr.03.2009.1674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of pericardial tamponade caused by hypothyroidism. A 66-year-old man presented with acute chest pain radiating to the back. Computed tomography ruled out an aortic dissection but revealed a large pericardial effusion, which was confirmed on transthoracic echocardiography showing features of tamponade. The effusion was drained and subsequent thyroid function tests showed profound hypothyroidism. No other cause of the pericardial effusion could be identified. Despite the prompt initiation of levothyroxine (T4) replacement therapy, the effusion re-accumulated over a period of 10 days and required further drainage. Following that, aggressive thyroxine replacement therapy using liothyronine (T3) was initiated and there was no further re-accumulation. Hypothyroidism should be suspected in any cases of pericardial effusion where the cause is not obvious. We should be vigilant of re-accumulation, and T3 replacement therapy should be considered in that situation.
Collapse
Affiliation(s)
- Stephen Arthur
- Glenfield General Hospital, c/o Dr Loke, Groby Road, Leicester LE3 9QP, UK
| | | | | | | |
Collapse
|
13
|
Boixeda Viu R, Mauri Plana M, Icart Palau R, Capdevila Morell J. Paciente de 47 años con derrame pericárdico. Rev Clin Esp 2009; 209:396-7. [DOI: 10.1016/s0014-2565(09)72344-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
14
|
Braithwaite SS. Thyroid Disorders. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
15
|
Handler J. Hypertensive Emergency With Cardiac Tamponade Associated With Hypothyroidism. J Clin Hypertens (Greenwich) 2007; 9:67-72. [PMID: 17215663 PMCID: PMC8109977 DOI: 10.1111/j.1524-6175.2007.06343.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|