BACKGROUND
Pericardial effusions are considered to be present when accumulated fluid within the pericardial sac exceeds the small amount that is normally present, causing impairment in the diastolic filling of the right heart. This case demonstrates an uncommon presentation of a large
pericardial effusion by showing its relationship to
myxedema in a patient with untreated
hypothyroidism. CASE REPORT A 42-year-old man with a past medical history of
hypertension,
diabetes mellitus, and
opioid abuse presented to the emergency department due to altered mental status, for which he received
Narcan without resolution of symptoms. Computed tomography (CT) of the brain was without any acute intracranial abnormalities to explain the patient's altered mental status. CT chest reported a
pericardial effusion, with a subsequent transthoracic echocardiogram (TTE) showing a moderate-to-large circumferential effusion without right atrial/ventricular collapse and no
cardiac tamponade physiology. On further investigation, he was found to have severe
hypothyroidism with elevated
thyroid peroxidase antibodies. Endocrinology was consulted to start IV
levothyroxine and
liothyronine to treat autoimmune Hashimoto's
thyroiditis. Subsequent TTE after starting
hypothyroidism treatment showed an ejection fraction (EF) of 45-50% with mildly reduced left ventricular systolic function and moderate-to-large
pericardial effusion, with no evidence of tamponade physiology.
After treatment of
hypothyroidism, the thyroid panel, EF, and
pericardial effusion improved significantly. CONCLUSIONS This case illustrates the potential for suffering a large
pericardial effusion secondary to generalized
myxedema in a patient with severe
hypothyroidism from undiagnosed Hashimoto's
thyroiditis. It is important to recognize this condition for appropriate
therapy and prevention of worsening cardiac conditions.