A case of primary hypothyroidism initially presenting with massive pericardial effusion

Abstract

While mild pericardial effusion generally accompanies overt hypothyroidism, massive pericardial effusion or pericardial tamponade is rare and more frequently occurs in patients with severe hypothyroidism. Similarly, massive pericardial effusion as the initial presenting feature of newly diagnosed hypothyroidism is also quite uncommon. A 64 year old diabetic (DM) male patient presented to our clinic with a recent worsening of shortness of breath. Transthoracic echocardiography demonstrated the presence of massive pericardial effusion and a pericardiocentesis was performed. Laboratory examination showed elevated thyroid stimulating hormone (TSH), and decreased free thyroxine (fT4) and free tri-iodothyronine (fT3) levels. A diagnosis of primary hypothyroidism was made. 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. Keywords: Hypothyroidism, Pericardial effusion