Department of Internal Medicine, Northeast Georgia Medical Center, Gainesville, GA, USA.
Department of Cardiology, Cardiovascular Clinic of North Georgia, Gainesville, GA, USA.
Am J Case Rep. 2023 Sep 18;24:e940631. doi: 10.12659/AJCR.940631.
BACKGROUND Pericardial effusions are considered to be present when accumulated fluid within the pericardial sac exceeds the small amount that is normally present, causing impairment in the diastolic filling of the right heart. This case demonstrates an uncommon presentation of a large pericardial effusion by showing its relationship to myxedema in a patient with untreated hypothyroidism. CASE REPORT A 42-year-old man with a past medical history of hypertension, diabetes mellitus, and opioid abuse presented to the emergency department due to altered mental status, for which he received Narcan without resolution of symptoms. Computed tomography (CT) of the brain was without any acute intracranial abnormalities to explain the patient's altered mental status. CT chest reported a pericardial effusion, with a subsequent transthoracic echocardiogram (TTE) showing a moderate-to-large circumferential effusion without right atrial/ventricular collapse and no cardiac tamponade physiology. On further investigation, he was found to have severe hypothyroidism with elevated thyroid peroxidase antibodies. Endocrinology was consulted to start IV levothyroxine and liothyronine to treat autoimmune Hashimoto's thyroiditis. Subsequent TTE after starting hypothyroidism treatment showed an ejection fraction (EF) of 45-50% with mildly reduced left ventricular systolic function and moderate-to-large pericardial effusion, with no evidence of tamponade physiology. After treatment of hypothyroidism, the thyroid panel, EF, and pericardial effusion improved significantly. CONCLUSIONS This case illustrates the potential for suffering a large pericardial effusion secondary to generalized myxedema in a patient with severe hypothyroidism from undiagnosed Hashimoto's thyroiditis. It is important to recognize this condition for appropriate therapy and prevention of worsening cardiac conditions.
当心包囊内积聚的液体超过正常量时，就会出现心包积液，导致右心舒张期充盈受损。本例通过展示未经治疗的甲状腺功能减退症患者中黏液性水肿与大量心包积液的关系，展示了大量心包积液的一种不常见表现。
一名 42 岁男性，既往有高血压、糖尿病和阿片类药物滥用病史，因精神状态改变就诊于急诊科，接受了纳洛酮治疗，但症状未缓解。脑部 CT 未见任何急性颅内异常以解释患者的精神状态改变。胸部 CT 报告心包积液，随后经胸超声心动图（TTE）显示中等量至大量心包环周积液，右心房/心室无塌陷，无心包填塞生理学表现。进一步检查发现患者患有严重的甲状腺功能减退症，甲状腺过氧化物酶抗体升高。内分泌科会诊后开始静脉注射左甲状腺素和三碘甲状腺原氨酸治疗自身免疫性桥本甲状腺炎。开始治疗甲状腺功能减退症后进行的后续 TTE 显示射血分数（EF）为 45-50%，左心室收缩功能轻度降低，中等量至大量心包积液，无心包填塞生理学证据。甲状腺功能减退症治疗后，甲状腺功能检查、EF 和心包积液均显著改善。
本例说明了在未经诊断的桥本甲状腺炎引起的严重甲状腺功能减退症患者中，由于全身性黏液水肿可能会出现大量心包积液。识别这种情况非常重要，以便进行适当的治疗并预防心脏状况恶化。
