1. bookVolume 50 (2016): Issue 1 (January 2016)
Journal Details
License
Format
Journal
eISSN
1336-0329
First Published
30 Mar 2016
Publication timeframe
4 times per year
Languages
English
access type Open Access

Newly diagnosed primary hypothyroidism applicant with massive pericardial effusion and acute renal failure

Published Online: 22 Feb 2016
Volume & Issue: Volume 50 (2016) - Issue 1 (January 2016)
Page range: 24 - 26
Journal Details
License
Format
Journal
eISSN
1336-0329
First Published
30 Mar 2016
Publication timeframe
4 times per year
Languages
English
Abstract

Objective. While non-symptomatic pericardial effusion is seen in primary hypothyroidism, massive pericardial effusion is a very rare finding. In the literature, newly diagnosed primary hypothyroidism cases presenting with massive pericardial effusion or acute renal failure are present, but we did not encounter any case first presenting with combination of two signs. In this case report, primary hypothyroidism case that presenting with massive pericardial effusion and acute renal failure will be discussed.

Subject and Results. Forty-eight years old male patient was hospitalized with shortness of breath, chest pain, swelling of the eyelids and bilateral limbs complaints. On chest radiograph heart shadow was deleted, pleural effusion was present until the middle zone of the left lung. Biochemical parameters (urea, creatinine, alanine aminotransferase aspartate aminotransferase, lactate dehydrogenase, sodium, potassium, creatine kinase, Troponin I, CK-MB, erythrocyte sedimentation rate, c-reactive protein) and thyroid stimulating hormone (TSH, 52.6 μg/ml), free triiodothyronine (T3, 0.61pg/ml), free thyroxine (T4, 0.12 ng/dl), anti thyroperoxydase (343 IU/ml), anti thyroglobulin (1604 IU/ml), were analyzed. The patient underwent pericardiocentesis. Levothyroxine treatment started with a dose of 0.05 mg per day and increased gradually until the optimum dose provided. At the end of the third month, the values of TSH, free T4, and free T3 were measured (2.3 μg/ml, 1.1 ng/dl, 2.54 pg/ml, respectively). The patient recovered completely and pericardial effusion was not detected in echocardiography.

Conclusion. Massive PE and acute renal failure due to primary hypothyroidism is a rare clinical condition. Primary hypothyroidism should be kept in mind in patients with symptoms like shortness of breath, chest pain, and generalized edema; moreover, when acute renal failure and PE were detected. It should be considered that patient’s biochemical parameters can improve starting from the two weeks after levothyroxine treatment started with pericardiocentesis in severe symptomatic patients.

Keywords

Joshi B, Jones D, Rochford A, Giblin L. Hypothyroidism and associated acute renal failure. J R Soc Med 102, 199–200, 2009.10.1258/jrsm.2008.080302Search in Google Scholar

Little WC, Freeman GL. Pericardial disease. Circulation 113, 1622–1632, 2006.10.1161/CIRCULATIONAHA.105.561514Search in Google Scholar

Patil VC, Patil HV, Agrawal V, Patil S. Cardiac tamponade in a patient with primary hypothyroidism. Indian J Endocrinol Metab 15, S144–S146, 2011.10.4103/2230-8210.83358Search in Google Scholar

Rodrigo C, Gamakaranage CS, Epa DS, Gnanathasan A, Rajapakse S. Hypothyroidism causing paralytic ileus and acute kidney injury – case report. Thyroid Res 4, 7, 2011.10.1186/1756-6614-4-7Search in Google Scholar

Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klag MJ, Parfrey P, Pfeffer M, Raij L, Spinosa DJ, Wilson PW, American Heart Association Councils on Kidney in Cardiovascular Disease HBPRCC, Epidemiology, Prevention. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 108, 2154–2169, 2003.10.1161/01.CIR.0000095676.90936.80Search in Google Scholar

Thirone AC, Danieli RV, Ribeiro VM. [Massive pericardial effusion as initial manifestation of hypothyroidism]. Arq Bras Endocrinol Metabol 56, 383–387, 2012.10.1590/S0004-27302012000600007Search in Google Scholar

Recommended articles from Trend MD

Plan your remote conference with Sciendo