Severe Pericardial Effusion Due to Autoimmune Hypothyroidism With Levothyroxine Withdrawal and Systemic Lupus Erythematosus
DOI:
https://doi.org/10.15605/jafes.037.02.13Keywords:
pericardial effusion, pericardial tamponade, autoimmune hypothyroidism, systemic lupus erythematosus, case reportAbstract
The presence of autoantibodies is a common link between autoimmune hypothyroidism (AH) and Systemic Lupus Erythematosus (SLE). The coexistence of AH (Hashimoto’s Thyroiditis) and SLE is common; however, massive pericardial effusion (PEEF) with signs of tamponade is extremely rare and only a few cases have been reported in literature. We present a case of a 54-year-old female who came in with progressive dyspnea who was found out to have massive PEEF from overt AH and concurrent SLE, which was successfully managed medically. This gave us valuable insight that massive pericardial effusion occurring in overt hypothyroidism may be secondarily caused by other co-existing disease entities such as SLE. The importance of the correct diagnosis cannot be overemphasized, as this largely contributed to the successful management of this case.
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Castier MB, Albuquerque, Menezes ME, Klumb E, Albanesi Filho FM. Cardiac tamponade in systemic lupus erythematosus. Report of four cases. Arq Bras Cardiol. 2000;75(5):446-8. https://pubmed.ncbi.nlm.nih.gov/11080755. https://doi.org/10.1590/s0066-782x2000001100008.
Patil VC, Patil HV, Agrawal V, Patil S. Cardiac tamponade in a patient with primary hypothyroidism. Indian J Endocrinol Metab. 2011;15(Suppl 2):S144-6. https://pubmed.ncbi.nlm.nih.gov/21966654. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169864. https://doi.org/10.4103/2230-8210.83358.
Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2015 Nov 7;36(42):2921-2964. https://pubmed.ncbi.nlm.nih.gov/26320012 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539677. https://doi.org/10.1093/eurheartj/ehv318
Antonelli A, Fallahi P, Mosca M, et al. Prevalence of thyroid dysfunctions in systemic lupus erythematosus. Metabolism. 2010;59(6):896-900. https://pubmed.ncbi.nlm.nih.gov/20005534. https://doi.org/10.1016/j.metabol.2009.10.010.
Paul R, Raychaudhuri P, Sinha P, Mookerjee S, Pandit K, Santra G. Prevalence of systemic lupus erythematosus among patients of hypothyroidism in a tertiary care center. Indian J Endocrinol Metab. 2012;16(4):569–74. https://pubmed.ncbi.nlm.nih.gov/22837918. . https://doi.org/10.4103/2230-8210.98013.
Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003;348(26):2646‑55. https://pubmed.ncbi.nlm.nih.gov/12826640. https://doi.org/10.1056/NEJMra021194.
Sinha A, Yeruva S, Kumar K, Curry B. Early cardiac tamponade in a patient with postsurgical hypothyroidism. Case Rep Cardiol. 2015;2015:310350. https://pubmed.ncbi.nlm.nih.gov/26294982. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534597. https://doi.org/10.1155/2015/310350.
Melmed S, Polonsky K, Larsen PR, Kronenberg H. Williams Textbook of Endocrinology, 13th ed. Elsevier; 2016.
Butala A, Chaudhari S, Sacerdote A. Cardiac tamponade as a presenting manifestation of severe hypothyroidism. BMJ Case Rep. 2013;2013:bcr2012005281. https://pubmed.ncbi.nlm.nih.gov/23389717. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603423. https://doi.org/10.1136/bcr-12-2011-5281.
Coetzee A, Kyriakakis C, Greyling C, Evans P. Cardiac Tamponade due to Hypothyroidism: A case cluster report. BMJ Case Reports 21, pages ber-2018-227275. DOI: 10.1080/16089677.2016.1191243
Doria A, Laccarino L, Sarzi-Puttini P, Atzeni F, Turriel M, Petri M. Cardiac involvement in systemic lupus erythematosus. Lupus. 2005;14(9):683-6. https://pubmed.ncbi.nlm.nih.gov/16218467. https://doi.org/10.1191/0961203305lu2200oa.
Spodick DH. Pericardial disease in the vasculitis-connective tissue disease group. In: The Pericardium. A comprehensive textbook, Marcel Dekker, New York; 1997.
Weich HSvH, Burgess L, Reuter H, Brice EA, Doubell AF. Large pericardial effusion due to systemic lupus erythematosus: A report of eight cases. Lupus. 2005;14(6):450-7. https://pubmed.ncbi.nlm.nih.gov/16038109. https://doi.org/10.1191/0961203305lu2131oa
Khanal R, Sharma T, Aziz F. Hashimoto’s disease presenting as cardiac tamponade. Endocrine Abstract. 2011;26:549.
Chen MC, Wu HH, Hsia CP. Syncope due to impending cardiac tamponade in Hashimoto’s thyroiditis. Acta Cardiol Sin. 2014;30(3):253-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804866. https://pubmed.ncbi.nlm.nih.gov/27122797.
Sarsam L. Onaiwu C, Devrieze B. “Hashimoto’s Heart”: Cardiac tamponade as presenting symptom in patient with severe hypothyroidism. Abstract 779. J Hosp Med. 2016;11(Suppl 1). https://shmabstracts.org/abstract/hashimotos-heart-cardiac-tamponade-as-presenting-symptom-in-patient-with-severe-hypothyroidism/.
Tirunagari A, Murthi S, Sadat B, Elango K. Impending cardiac tamponade as a primary presentation of Hashimoto’s thyroiditis. BMJ Case Rep. 2018;2018:br2018227275. https://pubmed.ncbi.nlm.nih.gov/30344160. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6203031. https://doi.org/10.1136/bcr-2018-227275.
Omura Y, Ugi S, Sugimoto T, Nishio Y, Maegawa H, Kashiwagi A. Massive pericardial effusion secondary to Hashimoto’s disease. Eur J Intern Med. 2007;18(5):438-40. https://pubmed.ncbi.nlm.nih.gov/17693236. https://doi.org/10.1016/j.ejim.2007.05.001.
Jameson J, Kasper D, Longo D, Fauci A, Hauser S, Loscalzo J (eds). Harrison’s Principles of Internal Medicine, 20th ed. Mc Graw Hill; 2018.
Chaudhari S, Wankhedkar KP, Mushiyev, S. SLE or hypothyroidism: Who can triumph in cardiac tamponade? BMJ Case Rep. 2015;2015: bcr2014206095. https://pubmed.ncbi.nlm.nih.gov/25750217. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4368996. https://doi.org/10.1136/bcr-2014-206095.
Abdullah N, Akbar R. Autoimmune thyroiditis as initial presentation of systemic lupus erythematosus complicated by massive ascites: A case report. J ASEAN Fed Endocr Soc. 2017;32(1):50-3. https://pubmed.ncbi.nlm.nih.gov/33442085. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7784115. https://doi.org/10.15605/jafes.032.01.09.
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