Myxoedematous tamponade as initial presentation of Hashimoto's thyroiditis

Abstract

Cardiac tamponade as the initial presentation of hypothyroidism is extremely rare. We report the case of a 48-year-old man admitted for acute respiratory distress, with cardiac ultrasound showing compressive pericardial effusion. Percutaneous pericardiocentesis was performed leading to a rapid clinical improvement. Laboratory tests confirmed severe hypothyroidism related to Hashimoto's disease. Despite hormone replacement therapy, pericardial effusion recurred after 3 weeks, requiring surgical drainage. Pericardial histology highlighted slight chronic fibrous pericarditis. The cardiac ultrasound scan performed 4 months later showed a well-tolerated chronic pericardial effusion. In conclusion, hypothyroidism should be suspected in case of cardiac tamponade especially in the absence of tachycardia, or in winter when myxoedema is prone to decompensation. Prognosis is generally good under hormone replacement therapy but ultrasound monitoring should be carried out at least until euthyroidism is achieved.

Keywords: heart failure; interventional cardiology; pericardial disease; thyroid disease.

Figure 1

ECG at admission with hypervoltage QRS complexes and repolarisation disorder in the anterolateral territory.

Figure 2

Chest X-ray at admission with increased cardiothoracic index.

Figure 3

Transthoracic cardiac ultrasound with circumferential fibrinous pericardial effusion (parasternal short axis view).

Figure 4

Transthoracic cardiac ultrasound with circumferential fibrinous pericardial effusion (apical four-chamber view).

Figure 5

Cardiac MRI with hypertrophic cardiomyopathy.