Cardiovascular Institute, Mutual Hospital Group of Grenoble, Grenoble, France.
Cardiovascular Institute, Mutual Hospital Group of Grenoble, Grenoble, France
BMJ Case Rep. 2020 Dec 31;13(12):e236342. doi: 10.1136/bcr-2020-236342.
Cardiac tamponade as the initial presentation of hypothyroidism is extremely rare. We report the case of a 48-year-old man admitted for acute respiratory distress, with cardiac ultrasound showing compressive pericardial effusion. Percutaneous pericardiocentesis was performed leading to a rapid clinical improvement. Laboratory tests confirmed severe hypothyroidism related to Hashimoto's disease. Despite hormone replacement therapy, pericardial effusion recurred after 3 weeks, requiring surgical drainage. Pericardial histology highlighted slight chronic fibrous pericarditis. The cardiac ultrasound scan performed 4 months later showed a well-tolerated chronic pericardial effusion. In conclusion, hypothyroidism should be suspected in case of cardiac tamponade especially in the absence of tachycardia, or in winter when myxoedema is prone to decompensation. Prognosis is generally good under hormone replacement therapy but ultrasound monitoring should be carried out at least until euthyroidism is achieved.
心脏压塞作为甲状腺功能减退症的初始表现极为罕见。我们报告了一例 48 岁男性因急性呼吸窘迫入院的病例，心脏超声显示有压迫性心包积液。进行了经皮心包穿刺术，导致临床迅速改善。实验室检查证实与桥本氏病相关的严重甲状腺功能减退症。尽管进行了激素替代治疗，但心包积液在 3 周后再次出现，需要手术引流。心包组织学显示轻微慢性纤维性心包炎。4 个月后进行的心脏超声检查显示慢性心包积液耐受良好。总之，在没有心动过速的情况下，特别是在冬季黏液性水肿容易失代偿的情况下，应怀疑甲状腺功能减退症导致的心脏压塞。在激素替代治疗下，预后通常良好，但应至少进行超声监测，直到达到甲状腺功能正常。
