Cardiac tamponade due to primary hypothyroidism: acute management and approach to prevent recurrence-a case report.
Cardiac tamponade
Case report
Hypothyroidism
Pericardial effusion
Journal
European heart journal. Case reports
ISSN: 2514-2119
Titre abrégé: Eur Heart J Case Rep
Pays: England
ID NLM: 101730741
Informations de publication
Date de publication:
Jun 2020
Jun 2020
Historique:
received:
03
10
2019
revised:
01
11
2019
accepted:
12
03
2020
entrez:
4
7
2020
pubmed:
4
7
2020
medline:
4
7
2020
Statut:
epublish
Résumé
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. 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. 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.
Sections du résumé
BACKGROUND
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
METHODS
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
CONCLUSIONS
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.
Identifiants
pubmed: 32617463
doi: 10.1093/ehjcr/ytaa071
pii: ytaa071
pmc: PMC7319808
doi:
Types de publication
Case Reports
Langues
eng
Pagination
1-5Informations de copyright
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
Références
BMJ Case Rep. 2011 Oct 04;2011:
pubmed: 22679149
BMJ Case Rep. 2014 May 26;2014:
pubmed: 24862423
Endocr Pract. 2005 Jul-Aug;11(4):265-71
pubmed: 16006302
Nat Rev Endocrinol. 2018 May;14(5):301-316
pubmed: 29569622
Indian J Endocrinol Metab. 2011 Jul;15(Suppl 2):S144-6
pubmed: 21966654
South Med J. 2002 May;95(5):475-80
pubmed: 12005003
Am J Med Sci. 2010 Oct;340(4):276-81
pubmed: 20601858
Kardiol Pol. 2015;73(9):786
pubmed: 26645063
BMJ Case Rep. 2013 Feb 05;2013:
pubmed: 23389717