ESPE Abstracts

Background: Massive pericardial effusion is uncommon complication of acquired hypothyroidism in children, and prompt drainage should be performed for impending tamponade. Thyroxine supplementation improves all clinical signs except profound growth failure, resulting poor catch-up growth.

Case presentation: 9 years 11month old girl was brought to emergency room with sudden worsening dyspnea for 1 day. Previously healthy girl showed weight increase of 10 kg during recent 1 year, and hypercholesterolemia was found during school health exam. She looked short and chubby with height 120 cm (<3rd percentile), weight 30 kg (25^th percentile) and BMI 20.8 (90~95 percentile). Her vital was as follows; respiration 22/min, pulse 65/min, BP 105/57 mmHg. She was prepubertal without goiter. Chest radiogram showed cardiomegaly, EKG was low-voltage. Echocardiogram showed massive effusion with fluctuating mitral inflow, reflecting impending tamponade. Effusion was drained by closed pericardiostomy. The effusion was exudate containing protein 5.6 g/dl, glucose 79 mg/dl, WBC 80/uL (mononuclear cell 90%) and LDH 460 IU/l. Bacterial and viral studies were all negative. Serum total cholesterol was 526 mg/dl with LDL-cholesterol 476 mg/dl. TFT showed hypothyroid with TSH >50 uU/ml, fT₄ 0.27 ng/dL. Thyroid autoantibodies were positive with anti-thyroglobulin Ab 154 IU/ml, anti-peroxydase Ab 282 IU/ml and TSH receptor Ab > 40 U/l. Thyroid scan revealed nearly non-visualization of left lobe. Thyroxine was replaced with no recurrence of pericardial effusion. During 1^st year of thyroxine therapy, growth velocity (GV) was 11.1 cm/year and height-S.D.s increased from −2.61 to −1.65 with rapid bone age (BA) progression (9.0–10.5 years). GV during next 6 months was decreased to 7.8 cm/yearr, but BA progressed rapidly to 11.5 years. Due to the anxiety of poor catch-up growth, growth hormone was tried for 6 months, resulting increased GV of 12.6 cm/year, and height-S.D.s of −1.10 at the end of 2^nd yearsr treatment.

Conclusion: Primary hypothyroidism should be included in the etiologic evaluation of massive pericardial effusion, especially associated with relative bradycardia. Additional growth promoting therapy should be considered for incomplete catch-up growth in prolonged hypothyroidism during thyroxine supplementation.