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BMJ Case Reports 2013; doi:10.1136/bcr-12-2011-5281
  • CASE REPORT

Cardiac tamponade as a presenting manifestation of severe hypothyroidism

  1. Alan Sacerdote
  1. Department of Medicine, Woodhull Medical Center, Brooklyn, New York, USA
  1. Correspondence to Dr Alan Sacerdote, Alan.Sacerdote{at}woodhullhc.nychhc.org

Summary

We report a patient who presented to our hospital with unusual symptoms of non-specific complaints and uncontrolled hypertension. Acute cardiac tamponade was suspected from cardiomegaly on routine chest x-ray and confirmed with an echocardiogram. Analysis of the pericardial fluid and other laboratory data ruled out all the common causes except for hypothyroidism as a cause of cardiac tamponade. Tamponade results from increased intrapericardial pressure caused by the accumulation of pericardial fluid. The rapidity of fluid accumulation is a greater factor in the development of tamponade than absolute volume of the effusion. Hypothyroidism is a well-known cause of pericardial effusion. However, tamponade rarely develops owing to a slow rate of accumulation of pericardial fluid. The treatment of hypothyroidic cardiac tamponade is different from other conditions. Thyroxine supplementation is all that is necessary. Rarely, pericardiocentesis is needed in a severely symptomatic patient.

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