Endocrine Abstracts

Introduction: Disturbances of the thyroid gland are the most common diseases of the endocrine system. Their prevalence is increasing with age and can be easily under diagnosed. Advanced forms of thyroid disease can mimic cardiovascular, psychiatric disorders, malignancy or other disorders and can result in life threatening conditions.

Case reports: In the current study we present two case reports concerning patients with cardiovascular symptoms. In both patients an extensive pericardial effusion was found as the first sign of undiagnosed hypothyroidism. The first patient (50-year-old woman), a pericardiocentesis was performed because of clinical and echocardiographic signs of cardiac tamponade. The pericardiocentesis resulted in a removal of effusion of 2560 ml. The second patient (34-year-old woman), the pericardial effusion was concentrated predominantly in a hardly accessible place. Therefore a conservative approach was decided also because of absence of clinical symptoms of tamponade and despite of a presence of a right atrial collapse. Both patients received levothyroxine replacement therapy in order to treat the hypothyroidism. No refill of pericardial effusion has occurred in the patient treated by pericardiocentesis. The volume of the pericardial effusion was reduced substantially in the patient treated conservatively.

Conclusions: In both patients insidious non-treated hypothyroidism can result in major cardiologic impairment. Correct diagnosis of hypothyroidism was of essential importance concerning successful treatment of pericardial effusion. A matter concerns the rate of replacement therapy: long lasting hypothyroidism could induce a recurrence of a pericardial effusion after pericardiocentesis or its progression in patient treated conservatively. In the contrary a rapid increasing of replacement dose could induce a heart failure or acute forms of coronary heart disease in patient with underlying coronary artery disease.

Supported by project CZ.2.17/1.1.00/32386.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This work was supported, however funding details unavailable.