Impending cardiac tamponade as a primary presentation of hypothyroidism: case report and review of literature.

OBJECTIVE

To describe a patient who presented with pericardial effusion and impending cardiac tamponade attributable to hypothyroidism.

METHODS

We present clinical, laboratory, and imaging data for the current patient and review the literature relative to clinical presentation, prevalence, pathophysiology, diagnosis, and treatment of pericardial effusion and tamponade.

RESULTS

In comparison with previously reported cases, our current case is rare, in that our patient, a 51-year-old woman, presented with impending cardiac tamponade as an initial manifestation of hypothyroidism. Echocardiography demonstrated a large pericardial effusion and diastolic right atrial collapse. A pericardial window procedure was performed, and 1,500 mL of fluid was removed. Levothyroxine therapy was initiated. One month later, recurrent pericardial effusion necessitated a similar intervention, after which the patient recovered and was managed by outpatient follow-up and monitoring of the thyrotropin level.

CONCLUSION

From our review of the literature, we conclude that impending cardiac tamponade is a rare initial manifestation of hypothyroidism. A high index of suspicion must be maintained for timely diagnosis of pericardial tamponade followed by prompt intervention. Recurrent pericardial effusions are common, necessitating close follow-up. Treatment of the hypothyroidism with levothyroxine is imperative.