methimazole and Pericardial-Effusion

A 23-year-old woman was diagnosed with Graves' disease 5 months ago with decompensated thyroid function, for which she is taking thiamazole and propranolol. She developed progressive respiratory dyspnoea [New York Heart Association (NYHA) class III] and frequent palpitations. On emergency admission, the patient was tachypnoeic, hypotensive (77/54 mm Hg) and tachycardic (120 beats per minute), with an oxygen saturation of 94%. She also presented with cold, swollen and shaky extremities, with extended capillary filling time, and a significant reduction in heart sounds. Echocardiogram showed massive pericardial effusion compatible with cardiac tamponade. Pericardiocentesis was performed, with a drainage of 1420 mL serosanguinolent fluid, with prompt haemodynamic recovery. Analysis of the pericardial fluid showed exudates. A diagnosis of pericardial effusion secondary to Graves' disease was determined and corticotherapy, lithium carbonate, cholestyramine and phenobarbital were prescribed. An oral iodine-131 was performed and the patient showed reasonable control of the clinical manifestations of hyperthyroidism. After 3 months, the patient showed no symptoms of hyperthyroidism and a new echocardiogram revealed a significant reduction in pericardial effusion.

Topics: Adult; Cardiac Tamponade; Female; Graves Disease; Humans; Methimazole; Pericardial Effusion; Pericardiocentesis; Young Adult

Hypothyroidism is relatively rare etiology of serositis with effusion, but massive pleural effusion is very unusual. This is a report of massive pleural effusion in patient taking methimazole after surgical resection of thyroid-stimulating hormone (TSH)-producing pituitary adenoma (TSHoma). The patient was clinically and biochemically hypothyroid and responded well to discontinuation of methimazole and thyroid hormone replacement therapy. When assessing patients with pleural effusion, we should not rely on laboratory test results alone, as a detailed medical history and thorough physical examination could be more useful.

Topics: Antithyroid Agents; Humans; Hypothyroidism; Male; Methimazole; Middle Aged; Pericardial Effusion; Pituitary Neoplasms; Pleural Effusion; Thyrotropin

Patients who have either hyperthyroidism or hypothyroidism can present with cardiovascular complications. These manifestations of thyroid disease-congestive heart failure, atrial tachyarrhythmias, atrioventricular conduction disorders, and mitral valve dysfunction-are well known to the clinician. Pericardial effusion is considered a complication of hypothyroidism; as an expression of thyrotoxicosis, it is extremely rare.Herein, we present the case of a 76-year-old woman who had pericardial effusion associated with thyrotoxicosis. She was treated with high-dose beta-blockers, methimazole, diuretics, and short-term steroids. She recovered completely, which precluded the need for pericardiocentesis. We suggest that thyrotoxicosis be considered in the differential diagnosis of pericardial effusion.

Topics: Adrenergic beta-Antagonists; Aged; Anti-Inflammatory Agents; Antithyroid Agents; Diuretics; Female; Furosemide; Glucocorticoids; Humans; Methimazole; Pericardial Effusion; Prednisone; Thyrotoxicosis