We report a case of a child who presented with huge pericardial effusion complicated to cardiac tamponade secondary to primary hypothyroidism. Due to the severity of cardiac tamponade, pericardiocentesis was performed to relieve the compression effect. The child improved with Levothyroxine treatment.
Hypothyroidism is a rare cause of pericardial effusion in children. If the pericardial effusion increases in volume, cardiac tamponade with clinical manifestations can result. The pericardial fluids may be rich in proteins and cholesterol. Treatment with thyroxine therapy can improve outcomes.
A three year old male presented to University Teaching Hospital of Butare (CHU Butare), Rwanda with a one month history of shortness of breath and lower limb edema. The physical examination revealed an acutely ill child in respiratory distress with tachypnea of 52 cycles per minute. Suprasternal, intercostal, and subcostal recessions were also observed. Crackles and distant heart sounds were heard on auscultation. The child presented hepatomegaly of 3 cm below costal margin. Both weight and height were in normal age ranges.
The differential diagnoses included congenital non-cyanotic heart disease, pericardial effusion, dilated cardiomyopathy with congestive heart failure, and pneumonia.
Heart ultrasound revealed huge pericardial effusion (4.1 cm) with tamponade effect. Treatment consisted of pericardiocentesis, oxygen therapy, corticosteroid, and diuretics (Furosemide). Pericardiocentesis yielded 550 ml of gold-brown fluid. Fluid bacteriology was negative. Fluid cyto-chemistry was also normal. After 2days, the child's condition improved. At this point, treatment was continued with Furosemide and Predinisolonne only, thinking about pericardial effusion of unknown origin . After 3 weeks,there was a huge pericardial effusion. Pericardiocentesis was again performed and 470 ml of gold-brown fluid was removed. As a result, hypothyroidism was suspected. Thyroid function revealed low T3: 1 pg/ml (normal range (1.4-4.98pg/ml) and high TSH: 15.857 microIU/ml (normal range: 0.4-7.0 microIU/ml).
The child was given Levothyroxine at 25 mcg per day increased to 50 mcg per day after two weeks. After 3 months, the child had normal thyroid function. T3 was 4.711pg/ml, T4 was 0.576 ng/dl, and TSH was 1.117 microIU/ml. Heart ultrasound revealed mild pericardial effusion without heart function compromise.
Conclusion: Hypothyroidism is an overlooked etiology of pericardial effusion and cardiac tamponade. Hypothyroidism should be considered in case of massive pericardial effusion without other common causes. Conservative management with thyroxine and thorough monitoring of effusion leads to excellent results. However, emergent pericardiocentesis should be considered in severe cardiac tamponade.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology