Massive Pericardial Effusion as the First Manifestation of Hypothyroidism in a Male Patient

This article intends to report a rare case of massive pericardial effusion as the first manifestation of hypothyroidism. A 45-year-old male patient, accompanied by a cardiology department, suddenly started to present signs of dyspnea and tiredness. He was submitted to an echocardiogram and diagnosed with dilated cardiomyopathy associated with a moderate pericardial effusion and low ejection of fraction. The laboratory tests showed elevated TSH levels （13.20 mIU/L）, what leads to the hypothyroidism diagnose and enable to start the treatment with levothyroxine. The patient has not followed correctly the treatment, reason why he has not showed any improves. He was admitted in the hospital to cardiology monitoring and the chest radiography confirmed an intense pericardial effusion. Then, the patient was submitted to the pericardiocentesis procedure, which was capable of remove the pericardial fluid for laboratory analysis and fragment of the pericardial sac for neoplastic cell research. After the hospital discharge, he was maintained in outpatient follow-up, when showed an important improvement in the clinical state.