Impending cardiac tamponade as a primary presentation of hypothyroidism: Case report and review of literature

Objective: To describe a patient who presented with pericardial effusion and impending cardiac tamponade attributable to hypothyroidism. Methods: We present clinical, laboratory, and imaging data for the current patient and review the literature relative to clinical presentation, prevalence, pathophysiology, diagnosis, and treatment of pericardial effusion and tamponade. Results: In comparison with previously reported cases, our current case is rare, in that our patient, a 51-year-old woman, presented with impending cardiac tamponade as an initial manifestation of hypothyroidism. Echocardiography demonstrated a large pericardial effusion and diastolic right atrial collapse. A pericardial window procedure was performed, and 1,500 mL of fluid was removed. Levothyroxine therapy was initiated. One month later, recurrent pericardial effusion necessitated a similar intervention, after which the patient recovered and was managed by outpatient follow-up and monitoring of the thyrotropin level. Conclusion: From our review of the literature, we conclude that impending cardiac tamponade is a rare initial manifestation of hypothyroidism. A high index of suspicion must be maintained for timely diagnosis of pericardial tamponade followed by prompt intervention. Recurrent pericardial effusions are common, necessitating close follow-up. Treatment of the hypothyroidism with levothyroxine is imperative.