Hypothyroidism-related cardiac tamponade can be successfully managed medically with levothyroxine in stable patients, while pericardiocentesis is required for those with hemodynamic instability.
Hypothyroidism should be considered in the differential diagnosis of pericardial effusion and cardiac tamponade, as medical therapy with levothyroxine can often resolve the effusion without invasive procedures in hemodynamically stable patients.
Thyroid dysfunction is a common incidental finding among healthy individuals. It can affect various organs of the body, including the heart. Among many other heart complications, it can lead to pericardial effusion by causing increased permeability of albumin across the pericardial membrane that leads to exudative pericardial effusion. In hypothyroidism, the fluid collection process occurs over a period of months, giving enough time for the pericardial membrane to stretch and accommodate the fluid within itself without causing any symptoms. Eventually, the pericardial membrane stretches to its maximum capacity and has no room to accommodate any more fluid, resulting in cardiac tamponade in the patients. Patients with hypothyroidism-related cardiac tamponade usually remain asymptomatic or present with atypical symptoms such as bradycardia and a normal heart rate or high blood pressure, and the diagnosis comes into light only when patients present to the hospital with hemodynamic instability. In these cases, echocardiography successfully detects large pericardial effusion with collapsed cardiac chambers. To treat hypothyroidism-related cardiac tamponade, treating the underlying condition has been very successful in the majority of the asymptomatic patients, but pericardiocentesis is required in emergencies to relieve symptoms of patients presenting with hemodynamic instability. We believe hypothyroidism-related cardiac tamponade is a preventable condition if detected and treated in outpatient settings by family physicians. This will prevent occurrence of various complications arising from hypothyroidism, including pericardial effusion. This will lead to a better quality of life among patients with the added benefit of reduced health care burden due to reduced frequency of hospital admissions of acutely ill patients.
Kaur et al. (Fri,) conducted a review in Hypothyroidism-related cardiac tamponade (n=8). Levothyroxine and/or Pericardiocentesis was evaluated. Hypothyroidism-related cardiac tamponade can be successfully managed medically with levothyroxine in stable patients, while pericardiocentesis is required for those with hemodynamic instability.