Cardiac tamponade as initial presentation of primary hypothyroidism
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Hashimoto disease
Pericardial effusion
Cardiac tamponade

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Alvarez-Lora, E. del C., Iglesias-Jiménez, Óscar G., Martelo-Herazo, C. A., Salgado-Montiel, L. G., & Quintana-Pájaro, L. de J. (2023). Cardiac tamponade as initial presentation of primary hypothyroidism. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 10(3).


Introduction: Pericardial effusion is a rare complication of hypothyroidism; its progression to tamponade is frequently underdiagnosed due to low clinical suspicion, causing delays in treatment and fatal complications. The only possible etiology was manifest hypothyroidism with myxedematous manifestations, with ultrasound suggestive of chronic autoimmune thyroiditis and positive antithyroid antibodies, with clinical stabilization after the pericardial window and further improvement with thyroid hormone replacement.
Objective: Identify patients with electrocardiographic signs of tamponade, such as electrical alternation, low voltage, added to bradycardia, and a chest X-ray with cardiomegaly, which allows us to think of hypothyroidism as an underlying etiology.
Case presentation: A 41-year-old male patient was admitted due to edematous syndrome and dyspnea, with clinical and laboratory findings suggestive of massive pericardial effusion and signs of cardiac tamponade. He was treated with pericardial drainage and levothyroxine.
Discussion: The causes of dyspnea in the patient who visits the emergency room are innumerable. The anamnesis and the semiological findings during the clinical evaluation are the starting point for its study. . Concerning hypothyroidism and dyspnea of cardiac origin, this has support based on which various physiopathological aspects converge.
Conclusions: The identification of individuals with risk factors for PH, its diagnosis, and treatments that have a positive impact on the reduction of symptoms and complications.
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Chaker L, Razvi S, Bensenor IM, Azizi F, Pearce EN, Peeters RP. Hypothyroidism. Nat Rev Dis Prim 2022 81 [Internet]. 2022 May 19 [cited 2022 Oct 22];8(1):1–17. Available from:

Chahine J, Ala CK, Gentry JL, Pantalone KM, Klein AL. Pericardial diseases in patients with hypothyroidism. Heart [Internet]. 2019 Jul 1 [cited 2022 Oct 22];105(13):1027–33. Available from:

Kabadi UM, Kumar SP. Pericardial effusion in primary hypothyroidism. Am Heart J. 1990 Dec 1;120(6):1393–5.

Chahine J, Jedeon Z, Chang KY, Jellis CL. Pericardial Manifestations of Thyroid Diseases. Curr Cardiol Rep [Internet]. 2022 Aug 1 [cited 2022 Oct 22];24(8):893–904. Available from:

Tissot C, Phelps CM, da Cruz EM, Miyamoto SD. Pericardial Diseases. In: Critical Care of Children with Heart Disease [Internet]. Cham: Springer, Cham; 2020 [cited 2022 Jul 21]. p. 503–22. Available from:

Cohen R, Loarte P, Opris S, Mirrer B, Cohen R, Loarte P, et al. Cardiac tamponade as the initial manifestation of severe hypothyroidism: A case report. World J Cardiovasc Dis [Internet]. 2012 Oct 30 [cited 2022 Oct 22];2(4):321–5. Available from:

Nusier M, Shah AK, Dhalla NS. Structure-function relationships and modifications of cardiac sarcoplasmic reticulum Ca2+-transport. Vol. 70, Physiological research. Czech Republic; 2021. p. S443–70.

Ates I, Kaplan M, Yilmaz N. Newly diagnosed primary hypothyroidism applicant with massive pericardial effusion and acute renal failure. Endocr Regul. 2016 Jan 1;50(1):24–6.

Kaur H, Chakwop Ngassa H, Elmenawi KA, Anil V, Gosal H, Mohammed L. Hypothyroidism-Related Cardiac Tamponade. Cureus. 2021 Oct 10;

Roy CL, Minor MA, Brookhart MA, Choudhry NK. Does This Patient With a Pericardial Effusion Have Cardiac Tamponade? JAMA [Internet]. 2007 Apr 25 [cited 2022 Oct 22];297(16):1810–8. Available from:

Yamanaka S, Kumon Y, Matsumura Y, Kamioka M, Takeuchi H, Sugiura T. Link between Pericardial Effusion and Attenuation of QRS Voltage in Patients with Hypothyroidism. Cardiology [Internet]. 2010 Jun [cited 2022 Oct 22];116(1):32–6. Available from:

Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, et al. American society of echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: Endorsed by the society for cardiovascular magnetic resonance and society of cardiovascular computed tomography. J Am Soc Echocardiogr [Internet]. 2013 Sep 1 [cited 2022 Oct 22];26(9):965-1012.e15. Available from:

Popoveniuc G, Chandra T, Sud A, Sharma M, Blackman MR, Burman KD, et al. A Diagnostic Scoring System for Myxedema Coma. Endocr Pract [Internet]. 2014 Aug 1 [cited 2022 Oct 22];20(8):808–17. Available from:

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