A case report on a rare manifestation of hypothyroid patient; cardiac tamponade

Here presented is a patient admitted to our hospital with cardiac tamponade, a rare manifestation of hypothyroidism. Her presentation was non-specific symptoms like easy fatigability, poor appetite and left anterior chest discomfort of 01 year duration. She was evaluated in our hospital before 05 months and was started on anti-tuberculous management. But despite the anti-tuberculous treatment her condition worsened and upon her current admission she has 01 episode of syncope. She was hypotensive and depressed. Pericardial fluid analysis showed a cell count of 200 cells per microliter but mycobacterium tuberculosis was not detected on AFB stain. Cytology of the pericardial fluid revealed just reactive effusion. 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. Our patient improved with levothyroxine treatment.Keywords:Cardiac, thyroid, patient.IntroductionPresenting this case is important for the following reasons:Pericardial effusion is a common clinical problem; though, cardiac tamponade is rarely a presenting manifestation of hypothyroidism.This patient presented with non specific symptoms to the extent that she was treated for tuberculous pericarditis, while the final diagnosis was severe hypothyroidism.Very few cases of hypothyroidic cardiac tamponade have been reported and this report will help clinicians to consider hypothyroidism as a possible cause of pericardial effusion, especially if other causes are less likely.___________________________*Correspondence Oumer Abdu MD, Internist, AssistantProfessor of Internal Medicine,University of Gondar, Northwest, Ethiopia.E-Mail:umerabdu88@gmail.comCASE (symptoms and signs)A 40 year old female presented to our hospital, University of Gondar hospital with a complaint of syncope, poor appetite, left anterior chest discomfort. She also has irregular menses which comes every 03-04 months and is just minimal. She additionally hasconstipation. She is taking anti tuberculous medications on the 6thmonth (at last month of scheduled course), after she was started on it empirically. Trial of empiric anti tuberculosis therapy is recommended in exudative pericardial effusion in tuberculosis endemic population[1]. According to the 2014 WHO Global TB report, 22 high burden countries account for 80 percent of the global TB cases and Ethiopia has the tenth highest TB burden in the world. She has no improvement despite it, but she failed to visit our hospital though. At admission, her blood pressure was 80/50 mmHg; pulse rate was 70 beats per minute. Respiratory rate was 20 per minute and Axillary temperature was 36.1 0C.On other systems, she had slightly pale conjunctivae, distant heart sounds, has positive sign of fluid collection in the abdomen (i.e. positive shifting \n