Karki Saurab, Rayamajhi Rabindra Jang, Shikhrakar Shreeja, Shahi Sunil, Dhakal Binaya, Khadka Manoj
Military Hospital, Sunsari, Nepal.
Department of Internal Medicine, Shree Birendra Hospital, Kathmandu, Nepal.
Ann Med Surg (Lond). 2021 Oct 30;72:102999. doi: 10.1016/j.amsu.2021.102999. eCollection 2021 Dec.
and importance: Hypothyroidism is an endocrine disorder with multiorgan involvement and various complications. One of the significant but less often seen complications is pericardial effusion. Since it can progress to life-threatening conditions like cardiac tamponade and hemodynamic instability, early diagnosis, and management of the pericardial effusion in hypothyroidism is a must.
We present a case of a 35-year-old male who presented with bilateral lower limb swelling, facial puffiness, cold intolerance, fatigue, and hoarseness of voice for one week. Laboratory investigation showed high thyroid-stimulating hormone (TSH), low triiodothyronine (T3), and raised serum anti-thyroid peroxidase (anti-TPO). The lipid profile demonstrated hypertriglyceridemia. Ultrasonography of the neck revealed normal thyroid size with decreased echo texture and increased vascularity. An electrocardiogram showed low voltage complexes with sinus bradycardia. 2D echocardiography revealed minimal pericardial effusion with normal ventricular function. The patient was managed with thyroxine therapy which gradually resolved his symptoms and pericardial effusion.
Pericardial effusion in hypothyroidism is due to the increased capillary permeability and albumin distribution volume and reduced lymph drainage in the pericardial cavity. Its presence in mild cases of hypothyroidism is uncommon although it can be seen in severe, long-standing hypothyroidism. Pericardial effusion in hypothyroidism, though rare, can present in mild cases and if overlooked can be fatal due to conditions like cardiac tamponade.
With early cardiac assessment and adequate thyroid replacement therapy, pericardial effusion in hypothyroidism can be reversible at an early stage. So, pericardial effusion which can be overlooked in mild cases of hypothyroidism needs to be identified and managed early.
及重要性：甲状腺功能减退症是一种累及多器官并伴有多种并发症的内分泌疾病。其中一种严重但较少见的并发症是心包积液。由于其可进展为危及生命的情况，如心脏压塞和血流动力学不稳定，因此早期诊断和处理甲状腺功能减退症患者的心包积液至关重要。
我们报告一例35岁男性患者，因双侧下肢肿胀、面部浮肿、畏寒、乏力及声音嘶哑一周前来就诊。实验室检查显示促甲状腺激素（TSH）升高、三碘甲状腺原氨酸（T3）降低以及血清抗甲状腺过氧化物酶（抗-TPO）升高。血脂检查显示高甘油三酯血症。颈部超声检查显示甲状腺大小正常，但回声质地减低且血管增多。心电图显示低电压复合波伴窦性心动过缓。二维超声心动图显示少量心包积液，心室功能正常。该患者接受甲状腺素治疗，症状及心包积液逐渐缓解。
甲状腺功能减退症患者的心包积液是由于心包腔内毛细血管通透性增加、白蛋白分布容积增大以及淋巴引流减少所致。虽然在严重、长期的甲状腺功能减退症中可见心包积液，但在轻度甲状腺功能减退症病例中并不常见。甲状腺功能减退症患者的心包积液虽罕见，但也可出现在轻度病例中，若被忽视，可能因心脏压塞等情况而致命。
通过早期心脏评估和充分的甲状腺替代治疗，甲状腺功能减退症患者的心包积液在早期阶段可逆转。因此，在轻度甲状腺功能减退症病例中可能被忽视的心包积液需要早期识别和处理。
