Severe hypothyroidism presenting as cardiac tamponade
Wide-spread availability of thyroid stimulating hormone assays and routine screening have resulted in early diagnosis of hypothyroidism. Affordable thyroid hormone replacement therapy has ensured that the prevalence of complications of untreated hypothyroidism including cardiovascular complications remains extremely low. Although pericardial effusion can be seen in hypothyroidism especially in severe cases, cardiac tamponade is uncommon. Cardiac tamponade as the first presenting feature of hypothyroidism is a rarity. A 60-year-old man with a history of hypertension and stroke was brought to the hospital with chief complaints of fall and altered mental status. In the emergency room, he was found to have hypothermia and drowsiness, and his laboratory investigations showed severe hypothyroidism. CT scan of chest revealed a large pericardial effusion and an echocardiogram showed evidence of cardiac tamponade. He was taken for an emergent pericardiotomy with a pericardial window. Pericardial fluid and serum investigations confirmed untreated hypothyroidism as the cause of cardiac tamponade. The patient was treated with aggressive thyroid hormone replacement therapy and his clinical condition improved. This case highlights the importance of screening and treatment of hypothyroidism in at-risk populations. If untreated, hypothyroidism may rarely lead to a potentially life-threatening complication such as cardiac tamponade.
Am j Hosp Med 2022 Oct;6(4): 2022.
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