Karu Andrew K, Khalife Wissam I, Houser Robert, VanderWoude John
University of South Dakota, School of Medicine, Internal Medicine Residency Program, Sioux Valley Hospital, Sioux Falls, South Dakota 57105, USA.
Endocr Pract. 2005 Jul-Aug;11(4):265-71. doi: 10.4158/EP.11.4.265.
To describe a patient who presented with pericardial effusion and impending cardiac tamponade attributable to hypothyroidism.
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.
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.
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.
描述一名因甲状腺功能减退症出现心包积液并即将发生心脏压塞的患者。
我们展示了该患者的临床、实验室及影像学数据，并回顾了有关心包积液和心脏压塞的临床表现、患病率、病理生理学、诊断及治疗的文献。
与先前报道的病例相比，我们的当前病例较为罕见，因为我们的患者是一名51岁女性，以即将发生心脏压塞作为甲状腺功能减退症的初始表现。超声心动图显示大量心包积液及舒张期右心房塌陷。进行了心包开窗术，抽出1500毫升液体。开始左甲状腺素治疗。1个月后，复发性心包积液需要类似干预，之后患者康复，并通过门诊随访及监测促甲状腺激素水平进行管理。
通过对文献的回顾，我们得出结论，即将发生心脏压塞是甲状腺功能减退症罕见的初始表现。必须保持高度怀疑指数，以便及时诊断心包压塞并随后迅速干预。复发性心包积液很常见，需要密切随访。使用左甲状腺素治疗甲状腺功能减退症至关重要。
