Pericardial effusion and cardiac tamponade in the setting of hyperthyroidism

IntroductionHyperthyroidism and cardiac disorders are almost common conditions(1). Chances for the development of sinus tachycardia, premature ventricular contraction, and atrial fibrillation increase with increases in thyroid hormones(2, 3) The risk factors increasing atrial fibrillation include age, late diagnosis of subclinical hyperthyroidism, and simultaneous heart failure and cardiac ischemia(4, 5).Subclinical hyperthyroidism increases the left atrial volume over time (cardiomyopathy). The mechanism of this disorder is the direct effect the thyroid hormone has on the heart and on the adrenergic system that increases cardiac function followed by hypertrophy due to the excessive cardiac output and increased activity of the rennin-angiotensin system(6, 7). Despite these common cardiac disorders, pericardial effusion associated with hyperthyroidism is still rare so that few articles contain case reports(8, 9). We report the case of patient with pericardial effusion and cardiac tamponade that developed following hyperthyroidism.Case definition: 69 year-old woman visited the hospital complaining mainly that she felt there was lump in her throat. She had not received any treatments since being diagnosed with hyperthyroidism two years previously. The chest radiograph indicated cardiac hypertrophy and pericardial effusion on the left side of the heart. Tests showed that the level of her thyroid-stimulating hormone was low but her free thyroxine level was normal. Echocardiography revealed pericardial effusion and cardiac tamponade. One thousand milliliters of fluid was removed during pericardiocentesis.Discussion: About 11 cases of pericardial effusion associated with hyperthyroidism have been recorded. However, in some reports the patients suffered from bloody pericardial effusion and cardiac tamponade, which was related to the drug heparin that they took. Like our patient, those in the other reports did not take anticoagulants.

کلیدواژه ها:

Pericardial effusion cardiac tamponade ، hyperthyroidism