Massive Pericardial Effusion as a Presentation of Hypothyroidism

A 46 year-old Hispanic female with no past medical history, and no history of trauma presented to the hospital with complaints of shortness of breath worsening gradually over past two months. The patient’s physical examination was remarkable for diminished heart sounds at auscultation. A complete blood count chemistry was within normal limit. Collagen vascular profi le was negative. A chest x-ray revealed enlarged cardiac shilloute suggestive of pericardial effusion. A computed tomography (CT) scan of chest showed massive pericardial effusion. A 2D-echocardiogram confi rmed the massive pericardial effusion without any evidence of right ventricular collapse. Pericardiocentesis was performed draining 2800 ml of straw-colored fl uid. Cultures and cytology of the pericardial fl uid were negative. Additional blood workup revealed an elevated thyroid stimulating hormone level. The patient was started on thyroid replacement therapy and had an uneventful recovery.