Key result
Oral levothyroxine completely resolves massive hypothyroid pericardial effusion without pericardiocentesis by day 16.
Why the study?
The clinical features of severe hypothyroidism may overlap with those of Down syndrome, delaying diagnosis until complications such as myxedema crisis and massive pericardial effusion develop.
Case Report (n=1)
No
Demonstrates that massive pericardial effusion secondary to severe hypothyroidism and myxedema crisis in adolescents with Down syndrome can be managed conservatively with thyroid hormone replacement and supportive care without therapeutic pericardiocentesis when cardiac tamponade is absent.
May support avoiding pericardiocentesis in tamponade-absent hypothyroid effusions; extends case reports but leaves open need for prospective confirmation.
The clinical features of severe hypothyroidism may overlap with those of Down syndrome, delaying diagnosis until complications such as myxedema crisis and massive pericardial effusion develop. Regular thyroid function screening is essential, and hypothyroidism‐associated massive pericardial effusion can often be treated conservatively with levothyroxine in the absence of cardiac tamponade.
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Mishra et al. (2026) conducted a case report in Severe autoimmune hypothyroidism complicated by myxedema crisis, massive pericardial effusion, and bilateral pleural effusions in Down syndrome (n=1). Oral levothyroxine and supportive care (hydrocortisone, non-invasive ventilation, inotropic support, antibiotics, therapeutic pleural drainage) was evaluated on Resolution of massive pericardial and pleural effusions and clinical recovery. Oral levothyroxine (100-125 μg/day) and supportive care completely resolved a massive hypothyroidism-associated pericardial effusion by day 16 without therapeutic pericardiocentesis.
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