Pericardial effusion associated with subclinical hypothyroidism

Dattilo, Giuseppe; Crosca, Sergio; Tavella, Stefania; Marte, Filippo; Patanè, Salvatore

doi:10.1016/j.ijcard.2009.03.090

Cited by 19 publications

(13 citation statements)

References 29 publications

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“…However subclinical thyroid dysfunction is currently the subject of numerous studies and remains controversial, particularly as it relates to cardiovascular morbidity and mortality and clinical applications [1,[25][26][27]. Pericardial effusion can be present in systemic disorders [28] including hypothyroidism [29,30]and subclinical hypothyroidism too [31]. Pericardial effusion is extremely rare as an expression of hyperthyroidism [32].…”

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confidence: 99%

Hashitoxicosis with pericardial effusion

Lamari

Dattilo

Tulino

et al. 2010

International Journal of Cardiology

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confidence: 99%

Hashitoxicosis with pericardial effusion

Lamari

Dattilo

Tulino

et al. 2010

International Journal of Cardiology

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“…A study published in 2010 found that out of 33 patients with cardiomegaly, only six patients were found with a low left ventricular ejection fraction (< 40%) [7]. Recent studies have shown that the incidence of pericardial effusion in severe hypothyroidism ranges from 30% to 80% and that this complication can be prevented and/or regresses slowly with adequate levothyroxine therapy [8,9].…”

Section: Discussionmentioning

confidence: 99%

Hypothyroidism: A Silent Killer in Young Patients

et al. 2017

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Hypothyroidism is considered by many as a "great mimicker" of many common complaints in the emergency department (ED). Thyroid disorders pose a significant threat when prolonged or in the acute presentation, and are potentially serious disorders with symptoms that range from non-specific constitutional to subtle or frank neuropsychiatric symptoms. Untreated disease can lead to myxedema crisis or coma, a life-threatening presentation that is rarely identified in young male patients and carries by itself a high risk of mortality, even in cases that undergo proper medical management. We present a case of a 26-year-old non-smoker Hispanic man with a medical history of hypothyroidism since the age of 13, and bronchial asthma. In a period of 3 -4 months, he developed generalized malaise, fatigue, cold intolerance and unintentional weight loss. He visited the ED after developing acute abdominal pain associated with non-bloody watery diarrheas. At the initial evaluation, vital signs revealed hypotension, borderline low heart rate, and hypoglycemia. On physical examination, he looked pale, appeared lethargic, with facial puffiness, macroglossia and bilateral hyporeflexia with delayed relaxation on muscle stretch reflexes. The laboratory results showed a thyroid stimulating hormone (TSH) of 314.75 uIU/mL. There was also low sodium and elevated creatinine and hepatic enzymes levels. Abdominopelvic CT scan incidentally revealed a large pericardial effusion that was later confirmed with echocardiogram. A diagnosis of myxedema crisis was established, prompt initiation of intravenous hydrocortisone, levothyroxine and triiodothyronine therapy was administered, and he was transferred to another institution for management of the pericardial effusion. This case raised concerns about the incidence where thyroid disease presentations are not identified and where patients fail to receive adequate medical therapy. We as primary care physicians should encourage patients to adhere to medical therapy and the recommended follow-up instructions to avoid catastrophic complications such as myxedema crisis.

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“…Subclinical hypothyroidism, defined by elevated serum levels of thyroid stimulating hormone (TSH) with normal serum levels of free thyroid hormones, (1) .Among individuals with this condition, up to half of them may progress to overt thyroid failure. When lasting more than 6-12 months, it may be associated with abnormal lipid metabolism, a subtle cardiac defect with mainly diastolic dysfunction, impaired vascular function, elevated risk of atherosclerosis and ischemic heart disease (2) . Restoration of euthyroidism by LT4 treatment may correct the cardiac abnormalities (3,4) .…”

Section: Introductionmentioning

confidence: 99%

“…Restoration of euthyroidism by LT4 treatment may correct the cardiac abnormalities (3,4) . Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroid hormones levels with suppressed TSH below the normal range (2) . It has been reported that subclinical hyperthyroidism is not associated with coronary heart disease but induces arrhythmias including arterial fibrillation and arterial flutter (2) .…”

Section: Introductionmentioning

confidence: 99%

“…Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroid hormones levels with suppressed TSH below the normal range (2) . It has been reported that subclinical hyperthyroidism is not associated with coronary heart disease but induces arrhythmias including arterial fibrillation and arterial flutter (2) . The more frequent causes of endogenous subclinical hyperthyroidism are toxic adenoma and Graves' disease; whereas the exogenous causes are induced by T4 therapy used to suppress TSH in patients with nontoxic goiter and differentiated thyroid cancer (DTC) (5) .The evidence indicates that the cardiovascular system responds to the minimal but persistent changes in circulating thyroid hormone levels, which is typical of individuals with subclinical thyroid dysfunction (3) .…”

Section: Introductionmentioning

confidence: 99%

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Effect of Subclinical Thyroid Disease on Cardiac Function in Patients on Thyroid Replacement Therapy as Assessed by Radionuclide Ventriculography

Mohamed

2013

The Egyptian Journal Nuclear Medicine

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Objective:The evidence indicates that the cardiovascular system responds to the minimal but persistent changes in circulating thyroid hormone levels, which is typical of individuals with subclinical thyroid dysfunction. However, there is no study to compare between control or euthyroid and subclinical thyroid cases with tong-term L-thyroxine therapy regarding cardiac function of the heart using radionuclide ventriculography. The objective of our study is to assess and compare the left ventricular function through the evaluation of the radionuclide systolic parameters, diastolic parameters and heart rate for these conditions. Methods: Ten healthy controls and 32 patients with surgically treated differentiated thyroid carcinoma followed by radioactive iodine ablation and receiving suppressive L-thyroxine were evaluated by gated radionuclide ventriculography. The patients were divided into 3 groups according to their thyroid hormone profile. These groups were: euthyroid, subclinical hypothyroid, subclinical hyperthyroid groups. Results: Long-term L-thyroxine therapy significantly affected the left ventricular systolic function in patients with subclinical thyroid dysfunction. It prolonged TPER and TPFR in patients with subclinical hypothyroid dysfunction while it decreased TPER and TPFR in patients with subclinical hyperthyroid dysfunction. However, there was no effect on the euthyroid group. Conclusions: These abnormalities in cardiac function in subclinical hypo-or hyperthyroidism may lead to long-term effect on patient's lives. Early effective and accurate treatment for these patients is important to avoid the consequences of long term exposure of the cardiovascular system to small increases or decrease of thyroid hormone.

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Pericardial effusion associated with subclinical hypothyroidism

Cited by 19 publications

References 29 publications

Hashitoxicosis with pericardial effusion

Hashitoxicosis with pericardial effusion

Hypothyroidism: A Silent Killer in Young Patients

Effect of Subclinical Thyroid Disease on Cardiac Function in Patients on Thyroid Replacement Therapy as Assessed by Radionuclide Ventriculography

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