Baldwin Chelsey, Newman Jonathan D, Vallejo Franco, Peck Valerie, Greene Loren Wissner, Goldberg Ira J
Divisions of Endocrinology, Diabetes, and Metabolism, New York University Grossman School of Medicine, New York, NY, US.
Divisions of Cardiology, New York University Grossman School of Medicine, New York, NY, US.
J Endocr Soc. 2020 Aug 27;5(1):bvaa125. doi: 10.1210/jendso/bvaa125. eCollection 2021 Jan 1.
Thyroid hormone plays a critical role in cardiovascular function. Severe hypothyroidism can be associated with "myxedema heart" characterized by relative bradycardia and pericardial effusion. Effusions associated with severe hypothyroidism can be large. Despite the large volume of effusions, tamponade is not a common consequence. However, with the incorporation of echocardiography into routine practice for evaluation of effusion, echocardiographic findings suggestive of clinical tamponade occur frequently.
We report a series of 3 patients with large pericardial effusions secondary to severe hypothyroidism. These cases serve to demonstrate the discordance between echocardiographic signs consistent with tamponade with a patient's stable clinical hemodynamics. We also report the development of bronchial obstruction, a rare complication of a large effusion due to severe hypothyroidism.
While pericardial effusion associated with severe hypothyroidism has been described for decades, the echocardiographic findings may be less well known and may lead to unnecessary downstream testing or invasive management. We use our case series to facilitate a summary of what is known about the epidemiology, mechanism and physiology, and expected outcomes of myxedema associated pericardial effusion. Finally, in the setting of current paucity of clinical guidelines, we aim to familiarize clinicians with the phenomenon of pseudotamponade and suggest management strategies for myxedema associated pericardial effusion to guide clinicians to use conservative medical management in majority of cases.
甲状腺激素在心血管功能中起关键作用。严重甲状腺功能减退可伴有“黏液性水肿性心脏病”，其特征为相对心动过缓和心包积液。与严重甲状腺功能减退相关的积液可能很大。尽管积液量很大，但心包填塞并非常见后果。然而，随着超声心动图纳入评估积液的常规检查，提示临床心包填塞的超声心动图表现却经常出现。
我们报告了3例因严重甲状腺功能减退继发大量心包积液的患者。这些病例旨在证明与心包填塞一致的超声心动图征象与患者稳定的临床血流动力学之间的不一致。我们还报告了支气管阻塞的发生，这是严重甲状腺功能减退导致大量积液的一种罕见并发症。
虽然与严重甲状腺功能减退相关的心包积液已被描述数十年，但超声心动图表现可能不太为人所知，可能导致不必要的下游检查或侵入性治疗。我们利用我们的病例系列来总结关于黏液性水肿相关性心包积液的流行病学、机制和生理学以及预期结果的已知情况。最后，在目前临床指南匮乏的情况下，我们旨在使临床医生熟悉假性心包填塞现象，并提出黏液性水肿相关性心包积液的管理策略，以指导临床医生在大多数情况下采用保守药物治疗。
