Hypothyroidism Causing Pericardial Effusion: A Case Report

Primary Hypothyroidism Unleashing Severe Pericardial Effusion: Lessons Learnt From an Atypical Presentation of a Common Endocrine Condition

Primary hypothyroidism is a commonly encountered endocrine disorder and can be associated with pericardial effusion and cardiac tamponade in severe cases. Early detection of hypothyroidism is key since it is a potentially treatable and reversible cause of pericardial effusions. A 53-year-old female was admitted following a fall. The clinical history was remarkable, with symptoms of persistent tiredness and fatigue for six months. She had no known medical conditions and was not taking any regular medications. Vital signs were stable. Physical examination revealed bilateral pitting pedal oedema and a tense abdomen with shifting dullness. Cardiovascular and respiratory examinations were normal. Notably, the patient exhibited delayed relaxation of deep-tendon reflexes bilaterally at the patellar and ankle sites. Pertinent laboratory findings showed an elevated thyroid-stimulating hormone (TSH) level of 151.69 milliunits/L, a low free thyroxine (fT4) level of <5.4 pmol/L, a haemoglobin level of 85 g/L, and a markedly high anti-thyroid peroxidase antibody level of 957.35 IU/mL. An electrocardiogram revealed a normal sinus rhythm with a low-voltage QRS complex. Chest X-ray findings indicated cardiomegaly suggestive of left heart failure. An emergent transthoracic echocardiography (TTE) demonstrated a large pericardial effusion measuring 5.4 cm posterior to the left ventricle. The most likely aetiology in this case was severe primary hypothyroidism. She initially received intravenous liothyronine 10 micrograms every four hours, followed by oral liothyronine 5 micrograms twice a day in conjunction with levothyroxine 100 micrograms once a day. The adrenal reserve assessment was satisfactory. An urgent pericardiocentesis was performed, draining a total of 900 mL of serosanguinous fluid. Serial echocardiograms demonstrated the absence of residual effusion. Hypothyroidism is a relatively uncommon cause of pericardial effusion. By ensuring early detection and appropriate treatment, we can optimise patient outcomes and prevent potential complications associated with untreated hypothyroidism.

Pericardial effusion in hypothyroidism: A case report

Introduction

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.

Case presentation

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.

Clinical discussion

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.

Conclusion

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.

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Hypothyroidism is an endocrine disorder with multiorgan involvement.

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Pericardial effusion is a notable complication of hypothyroidism, occurring due to the increased capillary permeability and albumin distribution volume and reduced lymph drainage in the pericardial cavity.

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The incidence of pericardial effusion is higher in severe, long-standing hypothyroidism whereas it’s uncommon in early stages and mild form of hypothyroidism.

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If presents earlier, with early cardiac assessment and adequate treatment, pericardial effusion can be reversible at an early stage.

Hypothyroidism with elevated pancreatic amylase and lipase without clinical symptoms: A case report

BACKGROUND

Hypothyroidism is an endocrine disorder that has worldwide prevalence and can affect multiple organ systems. We report a case of hypothyroidism with elevated pancreatic amylase and trypsin without acute pancreatitis. No such case has been previously reported.

CASE SUMMARY

A 29-year-old woman did not pay much attention to a fever 4 d prior. During this time, she experienced anorexia and only drank a small amount of water every day. She did not present with abdominal distension, postprandial nausea, vomiting, cough or expectoration. After physical and laboratory examinations, the patient was diagnosed with hypothyroidism. During the course of the disease, hypothyroidism was generally accompanied by constantly increased pancreatic amylase and trypsin. After admission, the possible etiology of the patient was excluded and the concentrations of pancreatic lipase and amylase in serum were > 2000U/L (reference range 23-300 U/L) and 410 U/L (reference range 30-110 U/L), respectively. So we highly suspected that it may be acute pancreatitis. Interestingly, she never developed any complications associated with acute pancreatitis despite high levels of serum pancreatic amylase and trypsin, and she reported no symptoms of abdominal pain. Serum amylase and lipase decreased gradually after active thyroxine supplementation, and the patient was discharged from the hospital after active treatment.

CONCLUSION

This case suggests that clinicians should pay attention to hypothyroidism with elevated pancreatic amylase and trypsin, even if no complications of acute pancreatitis are reported.