A Case of Pericardiocentesis in Myxedema with Pericardial Effusion / 대한내분비학회지

ABSTRACT

Myxedema is the nonpitting edema caused by the accumulation of glycosaminoglycans in subcutaneous and other interstitial tissue that occurs in hypothyroid patients. It is most often present in long-standing or severe primary hypothyroidism. While pericardial effusion appears to be a frequent occurrence in patients with myxedema, the development of cardiac tamponade in hypothyroid patients is distinctly unusual because of the slow formation of the pericardial effusion and the ability of the pericardium to distend. Recently we experienced a case of myxedema with pericardial effusion. The patient was 39-year-old female who was admitted due to aggrevated dyspnea for 1 month. She was obese and myxedematous. Chest X-ray revealed marked cardiomegaly. Two-dimensional echocardiography imaged massive pericardial effusion, especially left ventricular posterior wall and right ventricular side. The thyroid function test showed an obvious hypothyroid state. The patient was intubated and given controlled ventilation because of labored breathing, hypoxemia, and hypercapnea. After one half liter of straw-colored fluid was removed by pericardiocentesis, and she was given thyroid hormone replacement therapy, progressive clinical improvement was noted over course of next few weeks. We report this case with reviews of the literatures.