A Case of Profound Hypothyroidism Presenting with Hypertensive Emergency and Large Amount of Pericardial Effusion

Abstract

BACKGROUND Thyroid function is closely related to the cardiovascular system. Pericardial effusion is a well-known complication of hypothyroidism. It is common for massive pericardial effusion to progress to tamponed heart with hypotension, but not high blood pressure. CASE REPORT A 46-year-old woman presented to the hospital with dysarthria and left-side weakness of the upper limb which had started 30 minutes before her arrival at the hospital. The patient showed hypertensive emergency (213/124 mmHg) with intracerebral hemorrhage. Further evaluation for high blood pressure and transthoracic echocardiography demonstrated the presence of a large amount of pericardial effusion, and urgent pericardiocentesis was performed. The laboratory examination showed elevated thyroid-stimulating hormone and decreased free thyroxine level, leading to a diagnosis of primary hypothyroidism. The administration of current medications was maintained, including thyroid hormone replacement and anti-hypertensive drugs. CONCLUSIONS A rare case of profound hypothyroidism presenting with hypertensive crisis and massive pericardial effusion is described in this report.

Figure 1.

Non-contrast brain computed tomography showing intracranial hemorrhage on the right basal ganglia, right thalamus, and right periventricular white matter.

Figure 2.

(A) Electrocardiogram showing normal sinus rhythm. (B) Chest X-ray showing the “water bottle” sign, indicating a large cardiomegaly.

Figure 3.

Pre-pericardiocentesis echocardiographic findings. Transthoracic echocardiography showed a circumferential large amount of pericardial effusion (maximal thickness, about 30 mm at the posterior side of the ventricular wall) with slight compression of the right atrium and right ventricle. Left ventricular systolic function was preserved. (A) A large amount of pericardial effusion was observed on the parasternal long-axis view and parasternal short-axis views. (B) A large amount of pericardial effusion was also observed in various apical views.

Figure 4.

Post-pericardiocentesis echocardiographic findings. (A) Pericardial effusion was not observed on the parasternal long-axis view or parasternal short-axis views. Definite concentric left ventricular hypertrophy was detected on the parasternal long-axis view. (B) Pericardial effusion was not observed on various apical views. (C) The mitral valve inflow velocity in terms of E and A velocity and mitral annulus tissue Doppler velocity as e’ and a’ velocities were clearly detected after pericardiocentesis.