Myxedema Coma Complicated by Pericardial Effusion and Early Cardiac Tamponade

Q: What are the key findings of this study?

In a 70-year-old female with myxedema coma and early cardiac tamponade, prompt pericardiocentesis combined with intravenous hydrocortisone and levothyroxine led to rapid clinical recovery.

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Myxedema coma complicated by pericardial effusion and early cardiac tamponade (n=1). Intervention: Pericardiocentesis, intravenous hydrocortisone, and levothyroxine. Primary outcome: Clinical recovery and resolution of pericardial effusion and myxedema.

Q: What does this research mean for the field?

Prompt pericardiocentesis combined with intravenous stress-dose steroids and thyroid hormone replacement leads to clinical recovery in myxedema coma complicated by early cardiac tamponade. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hani Saad; Omar Horani; Joshua Truscinski; Susan Bennett; Stephen Grider

doi:10.7759/cureus.112848

July 17, 2026CureusOpen Access

Myxedema Coma Complicated by Pericardial Effusion and Early Cardiac Tamponade

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Key result

Prompt pericardiocentesis plus IV hydrocortisone and levothyroxine yields rapid recovery in myxedema coma with tamponade.

n=1

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Key Points

To report a case of myxedema coma presenting with severe decompensated hypothyroidism complicated by a large pericardial effusion and early cardiac tamponade.
Evaluated a 70-year-old female presenting after a fall with bradycardia, hypothermia, and severe primary hypothyroidism (TSH 61 mIU/L, free T4 <0.25 ng/dL).
Performed diagnostic computed tomography and echocardiography, followed by urgent pericardiocentesis, external rewarming, intravenous hydrocortisone (100 mg), and intravenous levothyroxine (200 mcg loading dose).
Pericardiocentesis and intravenous hormone therapy resolved cardiac tamponade and metabolic decompensation, enabling discharge after a five-day hospitalization.
Outpatient follow-up demonstrated reduction of pericardial effusion to a minimal amount and progressive normalization of TSH from 11.08 mIU/L at four weeks to 3.01 mIU/L at 12 weeks.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

A 70-year-old female with untreated hypothyroidism who presented with myxedema coma complicated by early cardiac tamponade and was successfully treated with pericardiocentesis, hydrocortisone, and levothyroxine.

I

Intervention

Urgent pericardiocentesis (800 mL drained), external forced-air warming system, intravenous hydrocortisone 100 mg, followed by intravenous levothyroxine 200 mcg loading dose then 100 mcg daily, and intravenous fluid replacement.

O

Outcome

Clinical recovery and resolution of pericardial effusion and myxedema coma.

Cardiac tamponade is a rare but life-threatening complication of myxedema coma that requires a high index of suspicion, especially in the absence of reflex tachycardia, and prompt intervention with pericardiocentesis and thyroid hormone replacement.

Implication

Emphasizes vigilance for tamponade in myxedema coma; leaves open need for prospective studies on management protocols.

Abstract

We report the case of a 70-year-old female with a history of hypothyroidism who presented following an unwitnessed fall with bradycardia and hypothermia. She was found to have myxedema coma complicated by signs of early cardiac tamponade, requiring urgent pericardiocentesis. Myxedema coma is a rare but life-threatening manifestation of severe decompensated hypothyroidism, carrying a high mortality rate despite treatment. It commonly presents with hypothermia and altered mental status and may be precipitated by infection, trauma, medication nonadherence, or cold exposure. Early recognition and prompt treatment with intravenous stress-dose steroids and thyroid hormone replacement are essential to improve outcomes. This case highlights the potentially severe complications of inadequately treated hypothyroidism. It emphasizes the importance of considering cardiac tamponade as a rare but life-threatening consequence of this disease, requiring a high index of suspicion, timely diagnosis, and urgent intervention.

Discussion

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Cite This Study

Saad et al. (2026) conducted a case report in Myxedema coma complicated by pericardial effusion and early cardiac tamponade (n=1). Pericardiocentesis, intravenous hydrocortisone, and levothyroxine was evaluated on Clinical recovery and resolution of pericardial effusion and myxedema. In a 70-year-old female with myxedema coma and early cardiac tamponade, prompt pericardiocentesis combined with intravenous hydrocortisone and levothyroxine led to rapid clinical recovery.

synapsesocial.com/papers/6a5b39118167787360d24ee7 https://doi.org/10.7759/cureus.112848

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Myxedema Coma Complicated by Pericardial Effusion and Early Cardiac Tamponade

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Myxedema Coma Complicated by Pericardial Effusion and Early Cardiac Tamponade

Figures

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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