{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:03:43Z","timestamp":1756310623892,"version":"3.37.3"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,9,17]],"date-time":"2022-09-17T00:00:00Z","timestamp":1663372800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,9,17]],"date-time":"2022-09-17T00:00:00Z","timestamp":1663372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Endocr Disord"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>In subjects with hypothyroidism, edema is often observed, and pleural effusion and pericardial fluid could be also observed. The color of such fluid retention is usually yellow. Here we show a very rare case with hypothyroidism who had bloody pleural effusion and bloody pericardial fluid.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 42-year-old male noticed chest pain and the aggravation of exertional dyspnea, and he was transported to our institution by emergency. He had Graves\u2019 disease and underwent total thyroidectomy about 4\u2009years before. After then, he had been treated with 200\u2009\u03bcg\/day of levothyroxine sodium for the maintenance of thyroid function. However, he self-interrupted such medication about 2\u2009years before. Thyroid function on admission was reduced as follows: free triiodothyronine, 1.60\u2009pg\/mL; free thyroxine &lt;\u20090.40\u2009ng\/dL; thyroid-stimulating hormone 25.50 \u03bcU\/mL. Inflammation markers were increased: white blood cells 25,280 \/\u03bcL; C-reactive protein 18.66\u2009mg\/dL. A large amount of pericardial fluid and pleural effusion were observed in chest and abdominal computer tomography and echocardiography. In addition, we performed pleural effusion and pericardial fluid collection. Pleural effusion in this subject showed bloody color, but not yellow. In cell block specimen of pleural effusion and pericardial fluid, red blood cells, neutrophils and lymphocyte component were observed. In this subject, however, we were unable to find any obvious background disease causing bloody pericardial effusion. Finally, we concluded that bloody pleural effusion and bloody pericardial fluid were brought about in a subject with untreated known hypothyroidism after total thyroidectomy, triggered by pneumonia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>In subjects with hypothyroidism, fluid and mucopolysaccharide are stored in interstitial space and protein osmolality is increased, thus leading to edema and fluid retention. It is noted here that pleural effusion and pericardial fluid in this subject showed bloody color and included red blood cells. There are no reports of bloody pericardial fluid with hypothyroidism. Therefore, it is important to keep in mind that a subject with some trigger, such as infection, may have a hematologic fluid retention that is not seen when hypothyroidism is present alone, as observed in this subject.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12902-022-01146-9","type":"journal-article","created":{"date-parts":[[2022,9,17]],"date-time":"2022-09-17T16:18:44Z","timestamp":1663431524000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Sudden extensive bloody pleural and pericardial effusion in a subject with untreated known hypothyroidism after total thyroidectomy, triggered by pneumonia"],"prefix":"10.1186","volume":"22","author":[{"given":"Yuichiro","family":"Iwamoto","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fuminori","family":"Tatsumi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yukino","family":"Katakura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazunori","family":"Dan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryo","family":"Wamata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohiko","family":"Kimura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masashi","family":"Shimoda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuhei","family":"Nakanishi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kohei","family":"Kaku","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoatsu","family":"Mune","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7898-1943","authenticated-orcid":false,"given":"Hideaki","family":"Kaneto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,9,17]]},"reference":[{"issue":"1","key":"1146_CR1","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1007\/s12020-019-02023-7","volume":"66","author":"B Biondi","year":"2019","unstructured":"Biondi B, Cooper DS. Thyroid hormone therapy for hypothyroidism. Endocrine. 2019;66(1):18\u201326.","journal-title":"Endocrine"},{"key":"1146_CR2","doi-asserted-by":"publisher","unstructured":"Parving HH, Hansen JM, Nielsen SL, Rossing N, Munck O, Lassen NA. Mechanisms of edema formation in myxedema--increased protein extravasation and relatively slow lymphatic drainage. N Engl J Med. (1979) 301, 460\u2013465.\u00a0https:\/\/doi.org\/10.1056\/NEJM197908303010902.","DOI":"10.1056\/NEJM197908303010902"},{"issue":"13","key":"1146_CR3","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1136\/heartjnl-2018-314528","volume":"105","author":"J Chahine","year":"2019","unstructured":"Chahine J, Ala CK, Genty JL, Pantalone KM, Klein AL. Pericardial disease in patients with hypothyroidism. Heart. 2019;105(13):1027\u201333. https:\/\/doi.org\/10.1136\/heartjnl-2018-314528.","journal-title":"Heart"},{"issue":"1","key":"1146_CR4","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1378\/chest.125.1.156","volume":"125","author":"V Villena","year":"2004","unstructured":"Villena V, Encuentra L, Lujan RG, Sustaeta JE, Martinez CJA. Clinical implications of appearance of pleural fluid at thoracentesis. Chest. 2004;125(1):156\u20139. https:\/\/doi.org\/10.1378\/chest.125.1.156.","journal-title":"Chest"},{"issue":"3","key":"1146_CR5","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1378\/chest.124.3.978","volume":"124","author":"JM Porcel","year":"2003","unstructured":"Porcel JM, Vives M. Etiology and pleural fluid characteristics of large and massive effusions. Chest. 2003;124(3):978\u201383.","journal-title":"Chest"},{"key":"1146_CR6","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1016\/0002-9343(90)90532-I","volume":"88","author":"PW Ladenson","year":"1990","unstructured":"Ladenson PW. Recognition and management of cardiocascular disease related to thyroid dysfunction. Am J Med. 1990;88:638\u201341.","journal-title":"Am J Med"},{"key":"1146_CR7","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1590\/S0066-782X2000001100008","volume":"75","author":"MB Castier","year":"2000","unstructured":"Castier MB, Albuquerque EM, Menezes ME, Klumb E, Albanesi Filho FM. Cardiac tamponade in systemic lupus erythematosus. Report of four cases. Arq Bras Cardiol. 2000;75:446\u20138.","journal-title":"Arq Bras Cardiol"},{"key":"1146_CR8","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1161\/01.CIR.52.5.823","volume":"52","author":"RE Kerber","year":"1975","unstructured":"Kerber RE, Sheeman B. 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A copy of the written consent is available for review by the Editor of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"We do not have any potential conflicts of interest relevant to this article.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"233"}}