Cardiomegaly associated with clinical hypothyroidism

Abstract

Introduction: Primary hypothyroidism corresponds to 95% of the total cases of hypothyroidism. Primary hypothyroidism is characterized as a clinical syndrome in which thyroid stimulating hormone (TSH) is above the reference values and free thyroxine (T4 L) below the limit of normality. These changes lead to a decrease in the basal metabolic rate that may affect the cardiovascular system. Severe cases can lead to a pericardial effusion and cardiomegaly. This case report describes an atypical manifestation hypothyroidism, the pericardial effusion, as an initial event of the disease, and aims to contribute to the medical literature, discussing a propaedeutic performed for diagnosis and describing a therapeutic response and clinical evolution. Case Report: A 44-year-old female patient; history of hypothyroidism undergoing irregular treatment. She was referred for elective computed tomography examination of the abdomen in nephrolithiasis investigation, but an important pericardial effusion was demonstrated without hemodynamic compromise. The chest X-ray showed an increase in the cardiac area and the echocardiogram showed a pericardial effusion (swinging heart aspect), paradoxical movement of the interventricular septum. The electrocardiogram showed no changes. During the investigation, T4 L was lower than 0.4 ng/dL, TSH: 319.9 uUI/mL, anti-hyroperoxidase: 142.3 IU/ml. Rheumatologic evaluation ruled out diseases. Faced with the hypothesis of pericardial effusion due to hypothyroidism, the patient then underwent levothyroxine treatment at a dose of 125mcg/day. Through 7 months of treatment there was a regression of cardiomegaly and pericardial effusion. The exams of January/2018 corroborate the hypothesis evidencing levels of T4 L: 1,2; TSH: 2.2 with normal imaging tests. Conclusion: In view of the rarity of the case, this work shows an oligosymptomatic patient, but with great repercussion in relation to the cardiological manifestation. The authors emphasize the importance of investigating thyroid function in patients with cardiac alterations.