Endocrine Abstracts

Context

Severe hypothyroidism and Systemic Lupus Erythematosus can both be causes for the development of pericarditis with concomitant pericardial effusion.

Case illustration

We report the case of a 23 year-old woman admitted in the ER for progressive dyspnoea, increasing fatigue and peripheral edema, associated with hepatosplenomegaly and polyadenopathy. Transthoracic echocardiogram confirmed severe pericardial effusion and an urgent pericardiocentesis and left evacuatory toracocentesis were performed. Pericardial fluid analysis was negative for any malignancy and infection. The patient was referred to an Endocrinology Unit, where she was diagnosed with primary autoimmune myxoedema (TSH = 56 UI/ml N:0.5–4.5; FT4 = < 5.15 pmol/l N:9–19; thyroperoxidase antibody titre = 949.87 mUI/ml N:0–35) and started on oral thyroxine replacement of 75 mg/day, following by a gradual improvement with this treatment. However, two weeks later, she was readmitted to the hospital where the recurrence of pericardial effusion was confirmed. New investigations showed an active systemic lupus erythematosus serology: low complement levels with C3 61 mg/dl (normal range 90–180 mg/dl) and C4 3.43 mg/dl (normal range 10–40 mg/dl), positive anti-nucleosome antibodies, raised C reactive protein (CRP) 5.9 mg/l (normal range 0–5 mg/l, elevated erythrocyte sedimentation rate (ESR) of 62 mm/h (normal range – 2–12 mm/h. The patient was started on methylprednisolone pulse therapy, then prednisone at 1 mg/kg/day and hydroxychloroquine 200 mg/day for active lupus, with favorable evolution.

Discussion

Autoimmune thyroid diseases can be frequently be associated with SLE. In this case, there is the possibility that both conditions might contributed to the development of pericardial effusion.