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Review
Pericardial diseases in patients with hypothyroidism
  1. Johnny Chahine1,
  2. Chandra K Ala2,
  3. James L Gentry2,
  4. Kevin M Pantalone3,
  5. Allan L Klein4
  1. 1 Department of Medicine, Cleveland Clinic, Fairview Hospital, Cleveland, Ohio, USA
  2. 2 Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3 Department of Endocrinology, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4 Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr. Allan L Klein, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA ; kleina{at}ccf.org

Abstract

Hypothyroidism is a well-known cause of pericardial effusion (with an incidence of 3%–37%) and can cause cardiac tamponade in severe cases. In this review, we present the current knowledge on the epidemiology of hypothyroid-induced pericardial diseases, the mechanism through which low thyroid hormone levels affect the pericardium, the associated clinical manifestations, diagnostic tests and management options. Hypothyroidism causes pericardial effusion through increased permeability of the epicardial vessels and decreased lymphatic drainage of albumin, resulting in accumulation of fluid in the pericardial space. Interestingly, autoimmunity does not seem to play a major role in the pathophysiology, and a majority of effusions are asymptomatic due to slow fluid accumulation. The diagnosis is generally made when the pericardial disease is associated with an elevated thyroid-stimulating hormone level, and other secondary causes are excluded. Management consists of thyroid replacement therapy, along with pericardial drainage in case of tamponade.

In conclusion, hypothyroidism-induced pericardial diseases are underdiagnosed. Initiating treatment early in the disease process and preventing complications relies on early diagnosis through systematic screening per guidelines.

  • pericardial disease
  • acute pericarditis
  • pericardial effusion
  • cardiac tamponade
  • hypothyroidism

https://doi.org/10.1136/heartjnl-2018-314528

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    Footnotes

    • Contributors All authors were all involved in the conception and design of. the study. All authors were involved in the drafting of the manuscript and revising it critically for important intellectual content. ALK made the final approval of the manuscript. All authors are in agreement to be accountable for. All aspects of the work and to ensure that questions related to the accuracy or integrity of any part of this work will be appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional unpublished data from the study.

    • Patient consent for publication Not required.