{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T00:13:32Z","timestamp":1775866412436,"version":"3.50.1"},"reference-count":25,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,2,15]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>A 23-year-old woman was diagnosed with Graves\u2019 disease 5\u2009months ago with decompensated thyroid function, for which she is taking thiamazole and propranolol. She developed progressive respiratory dyspnoea [New York Heart Association (NYHA) class III] and frequent palpitations. On emergency admission, the patient was tachypnoeic, hypotensive (77\/54\u2009mm Hg) and tachycardic (120 beats per minute), with an oxygen saturation of 94%. She also presented with cold, swollen and shaky extremities, with extended capillary filling time, and a significant reduction in heart sounds. Echocardiogram showed massive pericardial effusion compatible with cardiac tamponade. Pericardiocentesis was performed, with a drainage of 1420\u2009mL serosanguinolent fluid, with prompt haemodynamic recovery. Analysis of the pericardial fluid showed exudates. A diagnosis of pericardial effusion secondary to Graves\u2019 disease was determined and corticotherapy, lithium carbonate, cholestyramine and phenobarbital were prescribed. An oral iodine-131 was performed and the patient showed reasonable control of the clinical manifestations of hyperthyroidism. After 3\u2009months, the patient showed no symptoms of hyperthyroidism and a new echocardiogram revealed a significant reduction in pericardial effusion.<\/jats:p>","DOI":"10.1136\/bcr-2020-239772","type":"journal-article","created":{"date-parts":[[2021,3,8]],"date-time":"2021-03-08T11:05:14Z","timestamp":1615201514000},"page":"e239772","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Graves\u2019 disease inducing a massive cardiac tamponade"],"prefix":"10.1136","volume":"14","author":[{"given":"Elisabeth Martinez","family":"Fonseca","sequence":"first","affiliation":[{"name":"Internal Medicine, Roberto Santos General Hospital, Salvador, Bahia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Igor","family":"Schonhofen","sequence":"additional","affiliation":[{"name":"Internal Medicine, Roberto Santos General Hospital, Salvador, Bahia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Pereira","family":"Toralles","sequence":"additional","affiliation":[{"name":"DNA Laboratory, Salvador, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7957-0844","authenticated-orcid":false,"given":"Jozelio Freire","family":"de Carvalho","sequence":"additional","affiliation":[{"name":"Institute for Helath Sciences, Federal University of Bahia, Salvador, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,3,8]]},"reference":[{"key":"2025082708461423000_14.3.e239772.1","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1056\/NEJMra1510030","article-title":"Graves' disease","volume":"375","author":"Smith","year":"2016","journal-title":"N Engl J Med"},{"key":"2025082708461423000_14.3.e239772.2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(90)90253-T"},{"key":"2025082708461423000_14.3.e239772.3","first-page":"1","article-title":"Sanguineous pericardial effusion and cardiac tamponade in the setting of Graves' disease: report of a case and review of previously reported cases","volume":"2016","author":"Bui","year":"2016","journal-title":"Case Rep Med"},{"key":"2025082708461423000_14.3.e239772.4","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/95.3.188"},{"key":"2025082708461423000_14.3.e239772.5","first-page":"69","article-title":"An unusual complication in a patient with Graves' disease","volume":"124","author":"Khalid","year":"2011","journal-title":"N Z Med J"},{"key":"2025082708461423000_14.3.e239772.6","first-page":"56","article-title":"Pericardial effusion and tamponade complicating treated Graves' thyrotoxocosis","volume":"78","author":"Teague","year":"2009","journal-title":"Ulster Med J"},{"key":"2025082708461423000_14.3.e239772.7","doi-asserted-by":"crossref","first-page":"44","DOI":"10.15605\/jafes.030.01.03","article-title":"Thyrotoxic pericardial effusion complicating Graves\u2019 disease in pregnancy","volume":"30","author":"MGY","year":"2015","journal-title":"J ASEAN Fed End Soc"},{"key":"2025082708461423000_14.3.e239772.8","first-page":"1989","article-title":"[Tamponade caused by subacute pericarditis in Basedow's disease]","volume":"12","author":"Tourniaire","year":"1983","journal-title":"Presse Med"},{"key":"2025082708461423000_14.3.e239772.9","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.2169\/internalmedicine.44.1064","article-title":"A patient with Graves' disease accompanied by bloody pericardial effusion","volume":"44","author":"Nakata","year":"2005","journal-title":"Intern Med"},{"key":"2025082708461423000_14.3.e239772.10","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2016-215731","article-title":"Bleeding heart: a case of spontaneous hemopericardium and tamponade in a hyperthyroid patient on warfarin","volume":"2016","author":"Sajawal Ali","year":"2016","journal-title":"BMJ Case Rep"},{"key":"2025082708461423000_14.3.e239772.11","doi-asserted-by":"publisher","DOI":"10.1097\/01.md.0000101574.54295.73"},{"key":"2025082708461423000_14.3.e239772.12","first-page":"88","article-title":"Pericardial effusion as an expression of thyrotoxicosis","volume":"34","author":"Ovadia","year":"2007","journal-title":"Tex Heart Inst J"},{"key":"2025082708461423000_14.3.e239772.13","doi-asserted-by":"crossref","first-page":"e77","DOI":"10.1016\/j.ijcard.2009.03.131","article-title":"Hashitoxicosis with pericardial effusion","volume":"145","author":"Lamari","year":"2010","journal-title":"Int J Cardiol"},{"key":"2025082708461423000_14.3.e239772.14","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/4095789"},{"key":"2025082708461423000_14.3.e239772.15","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1590\/S0004-27302001000600014","article-title":"Tratamento do hipertireoidismo dA Doen\u00e7a de Graves","volume":"45","author":"Andrade","year":"2001","journal-title":"Arq Bras Endocrinol Metab"},{"key":"2025082708461423000_14.3.e239772.16","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1590\/S0004-27302009000700002","article-title":"Efeitos end\u00f3crinos E metab\u00f3licos das drogas antiepil\u00e9pticas","volume":"53","author":"Bortolini","year":"2009","journal-title":"Arq Bras Endocrinol Metab"},{"key":"2025082708461423000_14.3.e239772.17","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-37-2-308"},{"key":"2025082708461423000_14.3.e239772.18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197908303010902"},{"key":"2025082708461423000_14.3.e239772.19","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-66-3-485"},{"key":"2025082708461423000_14.3.e239772.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.cccn.2004.02.002"},{"key":"2025082708461423000_14.3.e239772.21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2019\/5748938","article-title":"Methimazole-Induced pleural effusion in the setting of Graves' disease","volume":"2019","author":"Khine","year":"2019","journal-title":"Case Rep Endocrinol"},{"key":"2025082708461423000_14.3.e239772.22","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s40360-017-0121-1","article-title":"Methimazole associated eosinophilic pleural effusion: a case report","volume":"18","author":"Gaspar-da-Costa","year":"2017","journal-title":"BMC Pharmacol Toxicol"},{"key":"2025082708461423000_14.3.e239772.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.autrev.2010.07.005"},{"key":"2025082708461423000_14.3.e239772.24","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1016\/j.medcli.2018.03.023","article-title":"Pleural effusion associated to metimazol","volume":"151","author":"Mart\u00edn Jim\u00e9nez","year":"2018","journal-title":"Med Clin"},{"key":"2025082708461423000_14.3.e239772.25","unstructured":"Marcocci C , Marino M . Thyroid-directed antibodies. In: Braverman LE , Utiger RD , eds. Werner & Ingbar\u2019s the thyroid: a fundamental & clinical text. Philadelphia, USA: Williams & Wilkins\/PA, 2005: 360\u201372."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-239772","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:46:25Z","timestamp":1756309585000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-239772"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3]]},"references-count":25,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3,8]]},"published-print":{"date-parts":[[2021,3]]}},"alternative-id":["10.1136\/bcr-2020-239772"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-239772","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3]]}}}