333 MASSIVE PERICARDIAL EFFUSION IN HYPOTHYROIDISM: A CASE REPORT

Abstract Chronic massive pericardial effusion (PE) without cardiac tamponade is relatively rare. Of all possible etiologies of PE, hypothyroidism an uncommon one. We reported a case 75-year-old woman, admitted at E.R. with confusion and unresponsive status, diffuse face lower limb'swelling . First-level examinations were performed: blood gas analysis showed hypoxia, respiratory acidosis severe anaemia; the EKG revealed slow atrial fibrillation ventricular rate approximately 40 bpm low QRS voltages. Echocardiogram sings suggestive tamponade. A CT-scan brain, chest abdomen was performed to exclude major active bleeding or neoplastic formations, confirmed presence PE. Eventually, drained pigtail catheter through sub-xiphoid approach. Meanwhile tests results TSH level 115 mIU/L (normal range 0,28–4,3 mIU/L) fT4 0,4 ng/L 8,0–17,0 ng/L). Severe, previously unknown, then diagnosticated specific treatment L-thyroxine started. PE formation in due several pathophysiologic mechanisms that include increased capillary permeability, extravasation hygroscopic mucopolysaccharides, volume albumin distribution, reduced lymphatic drainage, along increase salt water retention. The fluid accumulation space slow, chronic process, leading huge effusions no may represent complication hypothyroidism, which should be taken into account differential diagnosis underlying cause. best diagnostic tool, able provide useful information about location, hemodynamic impact effusion. Pericardiocentesis not normally required establish accurate etiological diagnosis, most cases can obtained simply on basis clinical history simple tests. Treatment aimed targeting cause, thus, our case, replacing missing hormone.