MYXEDEMA COMA PRESENTING AS LARGE PERICARDIAL EFFUSION WITH CARDIAC TAMPONADE

Abstract

INTRODUCTION
Myxedema coma is a life-threatening decompensated form of hypothyroidism with an underlying precipitating factor. It has a 20 to 40% mortality rate despite treatment. Most would present with decreased sensorium, hypothermia, hypotension, hyponatremia and hypoventilation. CASE
Myxedema coma is a life-threatening decompensated form of hypothyroidism with an underlying precipitating factor. It has a 20 to 40% mortality rate despite treatment. Most would present with decreased sensorium, hypothermia, hypotension, hyponatremia and hypoventilation. We present a case of a 48-year-old male, known to have chronic glomerulonephritis and hypertension, who came in due to a lacerated scalp wound sustained after a fall due to lethargy. His chest radiograph showed an enlarged cardiac silhouette. Electrocardiogram showed low voltage complexes. A transthoracic echocardiography revealed a severe pericardial effusion with tamponade. He then underwent emergency pericardial window. He was able to tolerate the procedure well but was noted to have decreased sensorium post-operatively. Further laboratory investigations showed severe hypothyroidism with an undetected FT4 and elevated TSH. He also had an elevated thyroid peroxidase antibody level suggesting an autoimmune etiology for the hypothyroidism. He was started on treatment with intravenous hydrocortisone followed by levothyroxine. His mental condition improved within few days and hydrocortisone was gradually tapered off. He was eventually discharged after a month and was maintained on oral levothyroxine replacement.

CONCLUSION
His mental condition improved within few days and hydrocortisone was gradually tapered off. He was eventually discharged after a month and was maintained on oral levothyroxine replacement.