Cardiac tamponade as the initial manifestation of severe hypothyroidism: A case report

Background: Hypothyroidism is a commonly seen condition. The presence of pericardial effusion with cardiac tamponade as initial manifestation of this endocrinological condition is very unusual. Objectives: In hypothyroidism pericardial fluid accu-mulates slowly, allowing adaptation and stretching of the pericardial sac, sometimes accommodating a large volume. Case Report: A 39 year-old female presented with chest pain, dyspnea and lower extremity edema for 1 day. Bradycardia, muffled heart sounds and severe hypertension were noticed. Chest radiograph showed an enlarged cardiac silhouette. A bedside echocardiogram revealed a cardiac tamponade, later she developed sudden hypotension and bradycardia that resolved after pericardiocentesis of 1 liter of pericardial fluid. The further laboratory evaluation revealed a TSH value of 69.3 miU/L and low T3 and free T4. The patient later developed reaccumulation of pericardial fluid with the need for creation of pericardial window. Conclusion: When the classic Beck’s triad is not present and bradycardia accompanies a cardiac tamponade, hypothyroidism should be strongly suspected. The requirement for thyroid hormone supplement is critical and is well reported. There is a chance of recurrence even after starting levothyroxine supplementation; and the associated hypertension usually requires treatment with more than one drug.