Endocrine Abstracts

JOINT3624

Background: Pleural and pericardial effusion is a rare complication of severe hypothyroidism in children but can be present in 10 to 30 % of adults. Most pediatric cases have been in children with Down syndrome, Pericardial effusion in hypothyroidism is due to the increased capillary permeability, albumin distribution volume and reduced lymph drainage in pericardial cavity. Its presence in mild cases of hypothyroidism is uncommon although it can be seen in severe, long-standing hypothyroidism. The management of pericardial effusions is with thyroid replacement with or without an intervention to drain the fluid. Several studies have shown successful management of hypothyroid-induced pericardial effusion with echocardiographic tamponade physiology, but not clinical cardiac tamponade, to be treated effectively with levothyroxine alone.

Case presentation: A 12-year-old Down syndrome female, presented to our ER with complaints of dyspnea. The condition started one week before admission with orthopnea, the child started to sleep only on sitting 45 degrees position + progressively increasing dyspnea for 5 days at start on effort then one day before admission she developed dyspnea at rest. She is a known case of Down Syndrome karyotyping + echo showing VSD 8 mm at one month old with no follow up Her Examination: HR 100 bpm – BP 100/70 mmHg, RR 30 cycles/min Temp. 36.4°c, her anthropometric measurements: Height 150 cm (-0.68 SD), Weight 68 kg(+ 1.9 SD), BMI 30.2 (98th percentile), cardiac examination: Heart distant heart sound with murmur at mitral area, general examination: facial features of down syndrome, bilateral Lower limbs edema up to sacrum, Neck showed goiter with resonant sternum. She withdrew routine labs + TSH and freeT4 for screening of hypothyroidism. Till results revealed she did echocardiogram showed VSD 10 mm and moderate pericardial effusion with clear fluid.

TSH more than 1500 microIU/ml, Free T4 0.6 ng/dl

The child received l troxin 50 mic/day + lasix IV + ACE Inhibitor

Follow up after one week echocardiogram showed mild pericardial effusion + VSD

Follow up after 2 weeks: TSH 30 free T4 0.98, no pericardial effusion.

Conclusions: Hypothyroidism is one of the uncommon etiology causing pericardial effusion. Even though it occurs in long-standing myxedema, it can occur in mild cases too, which when unnoticed can be fatal. Since with early cardiac assessment and adequate thyroid replacement therapy, the pericardial effusion due to hypothyroidism can be reversible, it needs to be identified and managed early.