Case of Massive Pericardial Effusion in Primary Hypothyroidism

Hypothyroidism is a common endocrine disorder. Pericardial effusion is frequently found in patients with hypothyroidism, but it is rarely associated with cardiac tamponade. Hypothyroidism complicated by cardiac tamponade is rarely reported in the medical literature. Here with we present a case of hypothyroidism presenting with a cardiac tamponade. A 27 year old lady presented with symptoms and signs suggestive of hypothyroidism. In addition, ECG and chest X-ray indicated and echocardiogram confirmed that the patient had a massive pericardial effusion. Under the guidance of echocardiography about 3 litres of pericardial fluid was aspirated through apical approach. The aspirated fluid was exudative and sterile. The patient improved symptomatically on pericardial aspiration, started on high dose thyroxine and is on regular follow-up. Considering high prevalence of thyroid disease, high degree of suspicion is mandatory while dealing with cardiac manifestations of thyroid disease. Since cardiac changes are completely reversible at least in initial stages of the disease, its imperative to have a high suspicion of thyroid disorders in cardiac cases. A diagnosis of hypothyroidism should be considered in the differential diagnosis of patients presenting with unexplained pericardial effusion, even in the absence of accompanying signs and symptoms of hypothyroidism.