Case 4

A wise decision

A 62 year old female patient presented with dyspnea to the cardiology unit for which she had ECG and Echocardiography done. She is known to be hypertensive and on β-blocker.

-Echocardiography: moderate pericardial effusion.

-She presented with her labs containing:

hypercholesterolemia

thyroid profile as:

-Free T₃: 0.18         -Free T₄: 0.15          -TSH:  168

We considered this case to have hypothyroidism with pericardial effusion as the sole unusual manifestation which tricked many physicians.

-Decision: start thyroid replacement therapy after thyroid proper examination.

-Eltroxin was started with a minimal dose (25µg) which will be increased gradually over two weeks to (50µg) after which the dose will be revised according to the patient's tolerability regarding clinical condition ( specially CVS) and thyroid profile.

 

-Moral of the story:

•Pericardial effusion caused by Hypothyroidism may be the sole manifestation.

•Don't give large doses of thyroxin from the start lest it cause many systems complications specially cardiac complications and particularly in old age.

 

-Update after 2 weeks of treatment:

-Clinically: dyspnea disappeared.

-Echocardiography

Pericardial effusion became mild (previously described to be moderate by the same operator)