A case report on a rare manifestation of hypothyroid patient; cardiac tamponade
Keywords:
Cardiac, thyroid, patient.Abstract
Here presented is a patient admitted to our hospital with cardiac tamponade, a rare manifestation of hypothyroidism. Her presentation was non-specific symptoms like easy fatigability, poor appetite and left anterior chest discomfort of 01 year duration. She was evaluated in our hospital before 05 months and was started on anti-tuberculous management. But despite the anti-tuberculous treatment her condition worsened and upon her current admission she has 01 episode of syncope. She was hypotensive and depressed. Pericardial fluid analysis showed a cell count of 200 cells per microliter but mycobacterium tuberculosis was not detected on AFB stain. Cytology of the pericardial fluid revealed just reactive effusion. 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. Our patient improved with levothyroxine treatment.
References
2. H Z. Das myxodemherz (Article in German). Munch Med Wschr. 1918;65(1180-3).
3. G. F. Myxedema heart J Am Med Assoc. 1925;84:345-9.
4. Kabadi UM1 KS. Pericardial effusion in primary hypothyroidism. Am Heart J. 1990; 120(6):1393-5.
5. Hardisty CA ND, Munro DS. . Pericardial effusion in hypothyroidism. Clin Endocrinol (Oxf) 1980;13:349-54.
6. B. B. Mechanisms in endocrinology: heart failure and thyroid dysfunction. Eur J Endocrinol. 2012;167:609-18.
7. Butala A CS, Sacerdote A. Cardiac tamponade as a presenting manifestation of severe hypothyroidism. BMJ Case Rep. 2013:1-3. doi:10.1136/bcr-12-2011-
5281
8. Smolar EN RJ, Avramides A, et al. Cardiac tamponade in primary myxedema and review of literature. 1976;272:345–52. Am J Med Sc. 1976;272:345-52.
9. Ates I KM, Yilmaz N. Newly diagnosed primary hypothyroidism applicant with massive pericardial effusion and acute renal failure. Endocr Regul. 2016;50(1):24-6.
10. Kust D KI, Peternac AŠ, et al. Pleural and pericardial effusions combined with ascites in a patient with severe sunitinib-induced hypothyroidism. Acta Clin Belg. 2016;71(3):175-7.
11. Zare-Khormizi MR RM, Pourrajab F, Akbarnia S. Massive pericardial effusion and rhabdomyolysis secondary to untreated severe hypothyroidism: the first report. Acta Clin Belg. 2014;69(5):375-8.
12. Ionescu SD TD, Ouatu A, Ambăruş V, Dosa A, Arsenescu-Georgescu C. Massive pericardial effusion associated with hypothyroidism. Rev Med Chir Soc Med Nat Iasi. 2014;118(1):87-91.
13. Ekka M1 AI, Aggarwal P, Jamshed N. Cardiac tamponade as initial presenting feature of primary hypothyroidism in the ED. Am J Emerg Med. 2014;32(6): 683
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