THE PATIENT WITH HYDROPERICARDIUM, HYDROTHORAX, ASCITES – THE CLINICAL CHALLANGE FOR INTERNIST

Hypothyroidism is caused by a deficiency of thyroid hormones and presents various clinical manifestations. The possibility of tissue edema should be mentioned in addition to the classic symptoms, such as cold intolerance, fatigue, constipation, bradycardia, depression, drowsiness, hoarseness, weight gain. Tissues edema and the formation of isolated effusions in the cavities (abdominal, pleural and pericardial) are not unusual in hypothyroidism. These manifestations are caused by increased vascular permeability and transudation of fluid and albumin into the interstitial and other spaces (pericardium, pleura), inadequate secretion of antidiuretic hormone, accumulation of hydrophilic glycosaminoglycans in the intercellular spaces of the dermis and various tissues. Multiple effusions in the body cavities and tissue edema are rare to happen simultaneously. The nonspecific nature of these symptoms requires a differential diagnosis, in which hypothyroidism is not always taken into consideration. This situation leads to delay in making a diagnosis and treatment administration, especially in comorbid patients. It is advisable to pay attention to the necessity of thorough analysis of the obtained data and the use of simple differential diagnosis algorithms for the hypothyroidism.