Dariya Sher Singh, Agrawal Deepak
Senior Consultant Physician, Medicine Department, S.M.S. Hospital, Jaipur, India.
Senior Faculty, General Medicine Unit, Central Hospital, North Western Railway, Jaipur, India.
Int J Endocrinol Metab. 2023 Jan 3;21(1):e131341. doi: 10.5812/ijem-131341. eCollection 2023 Jan.
A female patient, 48 years of age, with a complaint of recurrent episodes of diffuse chest pain, vertigo, and shortness of breath in the last five years, presented needing immediate medical attention.
The patient was evaluated and suspected of severe hypotension, cold hands, and feet with distended neck veins and muffled heart sounds. ECG revealed low voltage complexes and large pericardial effusion with a collapse in the diastole of the right auricle and ventricle. The provisional diagnosis was kept as pericardial effusion with hemodynamic compromise. Detailed history disclosed that she had suffered similar events five years before, during which a pericardial tap was performed, and the patient was on anti-tuberculosis treatment for nine months. The symptoms continued despite the treatments. She had a history of severe postpartum hemorrhage, failure of lactation, and early menopause with a history of hysterectomy dated ten years back. The biochemical study indicated decreased LH, FSH, TSH, ACTH, and serum cortisol levels. MRI brain revealed empty sella. The hormonal replacement was started with clinical improvement.
Although hypothyroidism is an extremely rare cause of pericardial effusion, detailed history and further investigations are imperative to form a definitive diagnosis.
一名48岁女性患者，主诉在过去五年中反复出现弥漫性胸痛、眩晕和呼吸急促，前来寻求紧急医疗救治。
对该患者进行评估后，怀疑其患有严重低血压、手足冰凉、颈静脉怒张且心音减弱。心电图显示低电压复合波以及大量心包积液，右心房和右心室舒张期出现塌陷。初步诊断为心包积液伴血流动力学受损。详细病史显示，她五年前曾发生过类似情况，当时进行了心包穿刺，患者接受了九个月的抗结核治疗。尽管接受了治疗，症状仍持续存在。她有严重产后出血、泌乳失败和早期绝经的病史，十年前有子宫切除术史。生化研究表明促黄体生成素、促卵泡生成素、促甲状腺激素、促肾上腺皮质激素和血清皮质醇水平降低。脑部磁共振成像显示空蝶鞍。开始进行激素替代治疗后临床症状有所改善。
尽管甲状腺功能减退是心包积液极为罕见的病因，但详细的病史和进一步检查对于明确诊断至关重要。
