Ilyas Hasan, Haider Muhammad, Furtado Caio, Gautam Amrit, Zahra Touqir
Department of Internal Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA.
Cureus. 2025 May 21;17(5):e84566. doi: 10.7759/cureus.84566. eCollection 2025 May.
Severe hypothyroidism can manifest with various cardiovascular complications, including bradycardia, diastolic dysfunction, and, less commonly, pericardial effusion, due to thyroid hormone's regulatory effects on cardiac function. While small pericardial effusions may be seen in clinical practice, large effusions and tamponade are rare. We present a case of a 64-year-old female patient with obesity who was initially admitted for bilateral lower extremity cellulitis. During her hospitalization, clinical signs such as lethargy, puffy facies, and slow speech raised concern for hypothyroidism, prompting thyroid function testing, which revealed severe hypothyroidism (thyroid-stimulating hormone 58.3 mIU/L, free T4 0.51 ng/dL). A transthoracic echocardiogram, obtained as part of further evaluation, demonstrated a moderate circumferential pericardial effusion without tamponade physiology. She was managed conservatively with oral levothyroxine, and cardiology advised against pericardiocentesis due to hemodynamic stability. Pericardial effusion in hypothyroidism typically resolves with hormone-replacement therapy. This case underscores the importance of considering hypothyroidism in patients with nonspecific systemic symptoms and highlights its potential to cause clinically significant but reversible cardiovascular complications.
严重甲状腺功能减退可表现为多种心血管并发症，包括心动过缓、舒张功能障碍，较少见的有心包积液，这是由于甲状腺激素对心脏功能具有调节作用。虽然临床实践中可能会出现少量心包积液，但大量积液和心脏压塞很少见。我们报告一例64岁肥胖女性患者，最初因双侧下肢蜂窝织炎入院。住院期间，患者出现嗜睡、面部浮肿和言语迟缓等临床症状，引起了对甲状腺功能减退的关注，促使进行甲状腺功能检查，结果显示为严重甲状腺功能减退（促甲状腺激素58.3 mIU/L，游离T4 0.51 ng/dL）。作为进一步评估的一部分，经胸超声心动图显示有中度心包环周积液，但无心脏压塞表现。患者接受口服左甲状腺素保守治疗，由于血流动力学稳定，心脏病专家建议不进行心包穿刺术。甲状腺功能减退所致的心包积液通常通过激素替代疗法得以缓解。该病例强调了在有非特异性全身症状的患者中考虑甲状腺功能减退的重要性，并突出了其导致具有临床意义但可逆的心血管并发症的可能性。
