Chandra, Evelyne and Qolbina, Firda Fitra and Suwanto, Denny and Oktaviono, Yudi Her (2026) A Two-Hit Model of Cardiac Tamponade: Myxedema-Associated Pericardial Effusion Complicated by Bacterial Pericarditis. International Journal of Drug Delivery Technology, 16 (5). 506 - 509.

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Abstract

Background: Severe hypothyroidism may lead to large pericardial effusion; however, progression to cardiac tamponade and neurological deterioration is uncommon. Myxedema coma represents the extreme manifestation of thyroid hormone deficiency and may coexist with cardiovascular instability. Case summary: A 61-year-old woman presented with progressive dyspnoea and decreased consciousness. Echocardiography demonstrated massive circumferential pericardial effusion with right atrial and right ventricular collapse consistent with cardiac tamponade. Thyroid function testing confirmed severe hypothyroidism (TSH 105.188 µIU/mL; FT4 0.05 ng/dL). Pericardial fluid culture grew Moraxella species. Altered mental status was attributed to combined low-output state and probable myxedema coma. Clinical improvement followed pericardiocentesis, thyroid hormone replacement, and targeted antibiotic therapy. Discussion: This case highlights the interaction between endocrine failure, infection, and mechanical cardiac compromise, emphasizing the need for comprehensive evaluation in hypothyroid patients presenting with large effusions and neurological decline. © 2026, Dr. Yashwant Research Labs Pvt. Ltd.All rights reserved.

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