{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:09:31Z","timestamp":1783123771701,"version":"3.54.6"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2020,5,4]],"date-time":"2020-05-04T00:00:00Z","timestamp":1588550400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Hypothyroidism is a common endocrine disorder resulting from deficiency of thyroid hormone, with iodine deficiency remains the foremost cause. It is more common in women with increasing incidence in the elderly. The manifestations of hypothyroidism results from the hypometabolism in the body at cellular level and affects all organs. Although there can be an incidental diagnosis of the disorder, the presentation with cardiac signs and symptoms is rare. We report a case of primary hypothyroidism with dysmorphic features manifesting as massive pericardial effusion with cardiac tamponade at presentation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A female aged 20 years presented with lethargy, constipation, and dyspnoea of 6\u2009months duration. On examination, she was short-statured and had dysmorphic features with hypotension, raised jugular venous pressure (JVP), muffled heart sounds, and thyroid stimulating hormone &amp;gt;100 uIU\/mL. Chest X-ray showed cardiomegaly and 2DEcho confirmed cardiac tamponade for which emergency pericardiocentesis was done.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Cardiovascular manifestations in hypothyroidism are dyspnoea and decreased exercise tolerance. Bradycardia, diastolic hypertension, cardiomegaly, and non-pitting or pitting peripheral oedema may be seen on physical examination. Mild pericardial effusion is common and generally asymptomatic. Massive pericardial effusion being manifested at presentation primarily as a sign of hypothyroidism is rare. A few cases have been mentioned in the literature in India and western population. Rarely, hypothyroidism presents with massive pericardial effusion resulting in cardiac tamponade as in our case.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaa071","type":"journal-article","created":{"date-parts":[[2020,5,3]],"date-time":"2020-05-03T20:48:31Z","timestamp":1588538911000},"page":"1-5","source":"Crossref","is-referenced-by-count":10,"title":["Cardiac tamponade due to primary hypothyroidism: acute management and approach to prevent recurrence\u2014a case report"],"prefix":"10.1093","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5579-0319","authenticated-orcid":false,"given":"Vikas Reddy","family":"Maddali","sequence":"first","affiliation":[{"name":"Department of Cardiology, Osmania General Hospital, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5206-2201","authenticated-orcid":false,"given":"Srikar","family":"Miryala","sequence":"first","affiliation":[{"name":"Department of Cardiology, Osmania General Hospital, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9844-0295","authenticated-orcid":false,"given":"Yagna Sreekanth","family":"Bellamkonda","sequence":"first","affiliation":[{"name":"Department of Cardiology, Osmania General Hospital, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1922-8000","authenticated-orcid":false,"given":"Praveen","family":"Nagula","sequence":"first","affiliation":[{"name":"Department of Cardiology, Osmania General Hospital, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,5,3]]},"reference":[{"key":"2020062620243547300_ytaa071-B1","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1038\/nrendo.2018.18","article-title":"Global epidemiology of hyperthyroidism and hypothyroidism","volume":"14","author":"Taylor","year":"2018","journal-title":"Nat Rev Endocrinol"},{"key":"2020062620243547300_ytaa071-B2","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1097\/MAJ.0b013e3181e664c6","article-title":"Hypothyroid cardiac tamponade: clinical features, electrocardiography, pericardial fluid and management","volume":"340","author":"Wang","year":"2010","journal-title":"Am J Med Sci"},{"key":"2020062620243547300_ytaa071-B3","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2014-204076","article-title":"Cardiac tamponade in hypothyroidism","volume":"2014","author":"Bajaj","year":"2014","journal-title":"BMJ Case Rep"},{"key":"2020062620243547300_ytaa071-B4","first-page":"1607","volume-title":"Endocrinology Adult and Pediatric","author":"Wiersinga","year":"2010","edition":"6th ed"},{"key":"2020062620243547300_ytaa071-B5","doi-asserted-by":"crossref","first-page":"786","DOI":"10.5603\/KP.2015.0168","article-title":"Cardiac tamponade as the first manifestation of primary hypothyroidism","volume":"73","author":"Hellmann","year":"2015","journal-title":"Kardiol Pol"},{"key":"2020062620243547300_ytaa071-B6","doi-asserted-by":"crossref","first-page":"144","DOI":"10.4103\/2230-8210.83358","article-title":"Cardiac tamponade in a patient with primary hypothyroidism","volume":"15","author":"Patil","year":"2011","journal-title":"Indian J Endocr Metab"},{"key":"2020062620243547300_ytaa071-B7","doi-asserted-by":"crossref","DOI":"10.1136\/bcr.04.2011.4117","article-title":"Pericardial decompression syndrome in a patient with hypothyroidism presenting as massive pericardial effusion: a case report and review of related literature","volume":"2011","author":"Lim","year":"2011","journal-title":"BMJ Case Rep"},{"key":"2020062620243547300_ytaa071-B8","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-12-2011-5281","article-title":"Cardiac tamponade as a presenting manifestation of severe hypothyroidism","volume":"2013","author":"Butala","year":"2013","journal-title":"BMJ Case Rep"},{"key":"2020062620243547300_ytaa071-B9","doi-asserted-by":"crossref","first-page":"265","DOI":"10.4158\/EP.11.4.265","article-title":"Impending cardiac tamponade as a primary presentation of hypothyroidism: case report and review of literature","volume":"11","author":"Karu","year":"2005","journal-title":"Endocr Pract"},{"key":"2020062620243547300_ytaa071-B10","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1097\/00007611-200295050-00003","article-title":"The diagnosis and management of hypothyroidism","volume":"95","author":"Guha","year":"2002","journal-title":"South Med J"}],"container-title":["European Heart Journal - 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