Relationship between Free Thyroxine and Islet Beta-cell Function in Euthyroid Subjects

Thyroid hormones have a specific effect on glucose-induced insulin secretion from the pancreas.We aimed to investigate the association between euthyroid hormones and islet betacell function in general population and non-treated type 2 diabetes mellitus(T2DM)patients.A total of 5089 euthyroid participants(including 4601 general population and 488 non-treated T2DM patients)were identified from a cross-sectional survey on the prevalence of metabolic diseases and risk factors in East China from February 2014 to June 2016.Anthropometric indices,biochemical parameters,and thyroid hormones were measured.Compared with general population,non-treated T2DM patients exhibited higher total thyroxine(TT4)and free thyroxine(FT4)levels but lower ratio of free triiodothyronine(T3):T4(P<0.01).HOMA-βhad prominently negative correlation with FT4 and positive relationship with free T3:T4 in both groups even after adjusting for age,body mass index(BMI)and smoking.When analyzed by quartiles of FT4 or free T3:T4,there were significantly decreased trend of HOMA-β going with the higher FT4 and lower free T3:T4 in both groups.Linear regression analysis showed that FT4 but not FT3 and free T3:T4 was negatively associated with HOMA-β no matter in general population or T2DM patients,which was independent of age,BMI,smoking,hypertension and lipid profiles.FT4 is independently and negatively associated with islet beta-cell function in euthyroid subjects.Thyroid hormone even in reference range could play an important role in the function of pancreatic islets.

Thyroxine treatment for elderly patients with heart failure and sick euthyroid syndrome

Objectives To evaluate the effect of thyroid hormone therapy with low dose of thyroxin on cardiac function in elderly patients with heart failure and sick euthyroid syndrome.Methods Forty-seven patients(33 males and 14 females,mean age 85.9+4.6 years,ranging from 80 to 99 years)with chronic heart failure(NYHAⅡ-Ⅳ)and low triiodothyronine(T_(3))state were randomly allocated to the treatment group or control group.The treatment group patients received oral administration of levothyroxine sodium(Euthyrox)25-50mg/d in addition to conventional therapy of heart failure,whereas patients in control group were given conventional therapy only.Serum level of total T_(3)(TT_(3)),free T_(3)(FT_(3)),total thyroxine(TT_(4)),free thyroxine(FT_(4)),and thyroid-stimulating hormone(TSH)were determined.For both groups,left ventricular ejection fraction(LVEF)and stroke volume(SV)were assessed by two-dimensional echocardiography before and at 8 weeks after treatment.The changes of these parameters after the treatment were evaluated by adjusting heart rate in the two groups.Results The reduced serum T_(3) level in the treatment group was corrected after thyroid hormone therapy,and these patients had a significant improvement in cardiac function after treatment.By contrast,in the control group only changes of serum TT_(3) and TT_(4) levels and SV and LVEF after treatment were statistically significant.The heart rate-adjusted mean SV and LVEF in both groups were also increased,which was significantly greater in the treatment group than in the control group.Conclusion In the elderly patients with heart failure and sick euthyroid syndrome,addition of thyroxine at a low dosage to the conventional treatment could effectively improve the low T_(3) state and cardiac function independent of changes of heart rate.

Determination of Thyroxine with Capillary Electrophoretic Enzyme Immunoassay

A Capillary electrophortic enzyme linked immunoassay with electrochemical detection (CE-EIA-ED) has been developed. The method can be used to determine thyroxine with a limit of 3.8×10-9 mol/L.

Ameliorating Effects of Thyroxine and Atropine in Phosphamidon Intoxicated Chick Embryos

The effects of thyroxine and atropine in ameliorating phosphamidon intoxication in chick embryos was studied. Treatment of phosphamidon significantly enhanced the moriality and abnormalityrates, decreased the average body weights, and cholinesterase activity in chick embryos. When thyroxine was administered to the phosphamidon intoxicated embryos, the above parameters changedsignificantly, indicating an ameliorating effect of thyroxine against phosphamidon intoxication in chick embryos. The combined thyroxine and atropine therapy did not further improve the ameliorating effect. Since in many respects chick embryo development parallels that of mammalian embryos,a short-term use of thyroxine as a protective agent against organophosphate toxicity might be useful

The effectiveness and safety of thyroxine replacement therapy for children with down syndrome and subclinical or congenital hypothyroidism—A systematic review

Introduction: Down syndrome (DS) is the most common chromosomal abnormality causing mental handicap in humans. Children with DS have significant medical problems and developmental delay which are further impaired by hypothyroidism. Those clinical features are potentially improved by using thyroxine replacement therapy. Objectives: To examine the evidence of effectiveness (motor & mental development) and safety of thyroxine supplementation in the treatment of SH and CH in children with DS. Methods: Several medical data bases (MEDLINE, EMBASE, CINAHL, Cochrane, Clinical Trials Gov, Essential Evidence and Google) were searched until 20 October, 2011, for randomized control trials (RCTs) that had examined thyroxine’s effectiveness and safety in the treatment of SH or CH in children with DS. Results: There were two high quality RCTs that examined thyroxine in the treatment of CH in children with DS, and no RCTs were found to have examined the effectiveness of thyroxine for SH in children with DS. Conclusion: The RCT which met our inclusion criteria provides the reliable evidence in recommending thyroxine for the treatment of CH in children with DS which is similar to the guidelines for general population. The absence of RCTs examining the treatment of SH in Children with DS indicates the need to conduct such trials.

The effect of maternal thyroxine injection on growth, survival and development of the digestive system of Nile tilapia, <i>Oreochromis niloticus</i>, larvae

The present study deals with the effect of exogenous treatment of O. niloticus females with L-thyroxine (T4) on the development of the digestive system during larval rearing, and its subsequent effect on larval growth and survival. The development of the digestive tract and accessory glands was investigated histologically and histochemically in the developing O. niloticus larvae, from control and T4-treated spawners. During yolk-sac absorption, the digestive system of the fish underwent further differentiation and the rudimentary alimentary canal became segmented into four different histological regions: the buccopharynx, oesophagus, stomach and intestine. The injection of females O. niloticus with thyroxine (1 or 10 μg T4/g BW) greatly enhanced the development of the digestive tract and accessory glands of larvae as indicated by the quantitative and qualitative changes of the mucus composition from predominantly neutral to a mixture of neutral and acid mucosubstances, or acid mucosubstances occurred during the rearing period for the larvae produced from T4-treated females. This may be due to the direct effect of exogenous thyroxine, which might have been transferred from maternal circulation into the oocytes and larvae, on the synthesis of proteins, which increased with larval development. Thus, thyroxine directly or indirectly improved O. niloticus larval growth, since a marked increase in both, length and weight of larvae occurred during the experimental period. In addition, larvae from treated females also gave a significantly higher survival rate than that of control. It could be concluded that exogenous T4 in maternal circulation might have been transferred into oocytes and larvae. The transferred thyroid hormone appears to play some role in the early development of larvae and may confer a distinct advantage for the growth of the offspring of the Nile tilapia, O. niloticus.

Cardiovascular mechanisms of thyroid hormones and heart failure:Current knowledge and perspectives

A multiple hormonal imbalance that accompanies heart failure(HF)may have a significant impact on the clinical course in such patients.The non-thyroidal illness syndrome(NTIS),also referred to as euthyroid sick syndrome or low triiodothyronine syndrome,can be found in about 30%of patients with HF.NTIS represents a systemic adaptation to chronic illness that is associated with increased cardiac and overall mortality in patients with HF.While conclusions on thyroid-stimulating hormone,free triiodothyronine,total and free thyroxine are currently unresolved,serum total triiodothyronine levels and the ratio of free triiodothyronine to free thyroxine seem to provide the best correlates to the echocardiographic,laboratory and clinical parameters of disease severity.HF patients with either hyper-or hypothyroidism should be treated according to the appropriate guidelines,but the therapeutic approach to NTIS,with or without HF,is still a matter of debate.Possible treatment options include better individual titration of levothyroxine therapy,combined triiodothyronine plus thyroxine therapy and natural measures to increase triiodothyronine.Future research should further examine the cellular and tissue mechanisms of NTIS as well as new therapeutic avenues in patients with HF.

Association between sensitivity to thyroid hormones and non-highdensity lipoprotein cholesterol levels in patients with type 2 diabetes mellitus

BACKGROUND Dyslipidemia and type 2 diabetes mellitus(T2DM)are chronic conditions with substantial public health implications.Effective management of lipid metabolism in patients with T2DM is critical.However,there has been insufficient attention given to the relationship between thyroid hormone sensitivity and dyslipidemia in the T2DM population,particularly concerning non-high-density lipoprotein cholesterol(non-HDL-C).AIM To clarify the association between thyroid hormone sensitivity and dyslipidemia in patients with T2DM.METHODS In this cross-sectional study,thyroid hormone sensitivity indices,the thyroid feedback quantile-based index(TFQI),the thyroid-stimulating hormone index(TSHI),the thyrotrophic T4 resistance index(TT4RI),and the free triiodothyronine(FT3)/free thyroxine(FT4)ratio were calculated.Logistic regression analysis was performed to determine the associations between those composite indices and non-HDL-C levels.Random forest variable importance and Shapley Additive Explanations(SHAP)summary plots were used to identify the strength and direction of the association between hyper-non-HDL-C and its major predictor.RESULTS Among the 994 participants,389(39.13%)had high non-HDL-C levels.Logistic regression analysis revealed that the risk of hyper-non-HDL-C was positively correlated with the TFQI(OR:1.584;95%CI:1.088-2.304;P=0.016),TSHI(OR:1.238;95%CI:1.034-1.482;P=0.02),and TT4RI(OR:1.075;95%CI:1.006-1.149;P=0.032)but was not significantly correlated with the FT3/FT4 ratio.The relationships between composite indices of the thyroid system and non-HDL-C levels differed according to sex.An increased risk of hyper-non-HDL-C was associated with elevated TSHI levels in men(OR:1.331;95%CI:1.003-1.766;P=0.048)but elevated TFQI levels in women(OR:2.337;95%CI:1.4-3.901;P=0.001).Among the analyzed variables,the average SHAP values were highest for TSHI,followed by TT4RI.CONCLUSION Impaired sensitivity to thyroid hormones was associated with high non-HDL-C levels in patients with T2DM.

Sequential defunctionalization followed by thyroxine supple-mentation as preoperative preparation of hyperthyroid patients undergoing thyroidectomy

Background Preparing hyperthyroid patients for thyroid surgery with a combination of antithyroid drugs and thyroxine has long been controversial because this combination usually results in only partial inhibition of thyroid function. We therefore used large doses of antithyroid drugs to completely inhibit the synthesis of thyroxine and render the thyroid gland defunctionalized. We then administered physiologic doses of thyroxine to inhibit thyroid-stimulating hormone secretion. We have named this treatment “sequential thyroid defunctionalization followed by thyroxine supplementation.” Methods Four hundred and seventy-one hyperthyroid patients seen at our hospital were divided into experimental and control groups. The control group was treated preoperatively with antithyroid drugs and iodine preparation. The experimental group was further divided into four subgroups and treated with “sequential thyroid defunctionalization followed by thyroxine supplementation”. Each of the four subgroups received different doses of antithyroid drugs and thyroxine for differing time periods. Thyroid function was assessed at each stage of treatment, as were operative blood loss volumes and postoperative complications. Results Compared to the control group, the four experimental groups showed less thyroid congestion and surface varices at surgery. Patients in subgroup A also had thyroid glands that were almost histologically normal. The mean operative blood loss volume of the experimental group was less than that of the control group （（326±163） ml in the control group; （196±57） ml in subgroup A; （230±71） ml in subgroup B; （240±80） ml in subgroup C; and （312±97） ml in subgroup D）. The postoperative complication rate of the experimental group was 8.64% （21/243） whereas that of the control group was 17.54% （40/228）. Conclusions Sequential thyroid defunctionalization followed by thyroxine supplementation is effective in reducing the bleeding volume and postoperative complication rate in selected hyperthyroid patients undergoing thyroidectomy.

Incubation temperature induced developmental plasticity of cold responsive physiological phenotypes in Japanese Quails

Embryonic development is a critical period for phenotype formation.Environmental variation during embryonic development can induce changes in postnatal phenotypes of animals.The thyroxine secretion and aerobic metabolic activity of small birds are important phenotypes closely related to their winter survival.In the context of climate change,it is necessary to determine whether temperature variation during incubation in birds leads to developmental plasticity of these cold responsive phenotypes.We incubated Japanese Quail(Coturnix japonica)eggs at 36.8℃,37.8℃,and 38.8℃,and raised the chicks to 35-day old at 22℃with same raising conditions,then all the quails were exposed to gradually temperature dropping environment(from 15℃to 0℃).After cold treatment,serum T3 level,resting metabolic rate,skeletal muscle and liver metabolomes of the birds were measured.The serum T3 levels were significantly lower in the 38.8℃group and significantly higher in the 36.8℃group compared to the 37.8℃group.The metabolic rate in the 38.8℃group was significantly lower compared to the 37.8℃group.Compared with the 37.8℃group,metabolites involved in the tricarboxylic acid cycle in the liver were significantly lower in the 38.8℃group,and metabolites related to lipid oxidation metabolism and fatty acid biosynthesis were significantly lower in the skeletal muscles in the 38.8℃group but significantly higher in the 36.8℃group.These results indicate that incubation temperature variation can lead to developmental plasticity in cold responsive physiological phenotypes.Higher incubation temperature may impair the capacity of birds coping with cold challenge.

Association of Serum Ferritin Levels and Thyroid Hormones

Thyroid metabolism is orchestrated by the action of various minerals and trace elements including iron, iodine, selenium, and zinc. Iron deficiency, specifically deficiency in serum ferritin levels, is one of the common causes of thyroid dysfunction. Our objective was to evaluate the relationship between serum ferritin levels and circulating thyroid hormones. For this, a retrospective analysis was performed on 16,512 individuals who tested for serum levels of ferritin and thyroid profile at Vibrant America Clinical Laboratories. Subjects were stratified based on the serum levels of ferritin. Age (p −0.03232, p < 0.0001). Analysis of Linear association by Pearson’s correlation exhibited a considerable correlation between varying serum ferritin levels with all tested thyroid hormones. The study concludes that serum ferritin levels were associated with thyroid hormone synthesis and metabolism in individuals with optimal levels of circulating ferritin.

Helicobacter pylori infection and drugs malabsorption

Drug absorption represents an important factor affecting the efficacy of oral drug treatment.Gastric secretion and motility seem to be critical for drug absorption.A causal relationship between impaired absorption of orally administered drugs and Helicobacter pylori(H.pylori)infection has been proposed.Associations have been reported between poor bioavailability of l-thyroxine and l-dopa and H.pylori infection.According to the Maastricht Florence Consensus Report on the management of H.pylori infection,H.pylori treatment improves the bioavailability of both these drugs,whereas the direct clinical benefits to patients still await to be established.Less strong seems the association between H.pylori infection and other drugs malabsorption,such as delavirdine and ketoconazole.The exact mechanisms forming the basis of the relationship between H.pylori infection and impaired drugs absorption and/or bioavailability are not fully elucidated.H.pylori infection may trigger a chronic inflammation of the gastric mucosa,and impaired gastric acid secretion often follows.The reduction of acid secretion closely relates with the wideness and the severity of the damage and may affect drug absorption.This minireview focuses on the evidence of H.pylori infection associated with impaired drug absorption.

Effect of treatment of overt hypothyroidism on insulin resistance

AIM: To investigate the impact of hypothyroidism and thyroxine therapy on insulin sensitivity in patients with overt hypothyroidism.METHODS: The study included twenty seven overtly hypothyroid and fifteen healthy euthyroid South Western Asian females.Both groups had matching age and body mass index.Physiological and pathological conditions as well as medications that may alter thyroid function,glucose homeostasis or serum lipids were ruled out.Serum thyrotropin(TSH),free tetraiodothyronine(FT4),free triiodothyronine(FT3),fasting insulin(FI),fasting plasma glucose(FPG),total cholesterol and triglycerides were measured before and six months after initiating thyroxine therapy for hypothyroid patients and once for the control group.Insulin resistance(IR) was estimated using homeostasis model assessment(HOMA-IR) and Body mass index(BMI) was calculated.RESULTS: Both study groups,hypothyroid patients and euthyroid control subjects,had matching age and body mass index(P-value 0.444,0.607 respectively).No significant difference was found between the hypothyroid patients and the euthyroid control group regarding fasting plasma glucose,fasting insulin,insulin resistance,total cholesterol and triglycerides(P-values 0.432,0.621,0.883,0.586,0.05 respectively).In the hypothyroid patients,triglycerides showed direct correlation to TSH and inverse correlation to FT3.Similarly total cholesterol inversely correlated to FT3 but its direct correlation to TSH did not reach statistical significance.After thyroxine replacement and reaching an euthyroid state as confirmed by clinical and laboratory data,there was no significant change in fasting plasma glucose,insulin resistance or triglyceride level(P-value 0.216,0.204,0.175 respectively) while total cholesterol significantly decreased(P-value 0.043) and fasting insulin significantly increased(P-value 0.047).CONCLUSION: Hypothyroidism has no impact on insulin sensitivity.Correction of hypothyroidism is not associated with a significant change of insulin sensitivity or triglycerides,but with a significant reduction of total cholesterol.

Changes in serum thyroid hormone levels and thyroid gland activity of artificially maturing female Japanese eel (Anguilla japonica)

In order to evaluate the involvement of the thyroid gland in reproduction, thyroid functioning was described in female cultivated Japanese eel (Anguilla japonica) in progressive stages of sexual maturation induced by chum salmon pituitary homogenate (SPH) treatment. Serum thyroid hormones, thyroxine (T4) and triiodothyronine (T3) were also measured in each stage. Thyroid gland activity (epithelial cell height) was high before SPH injection (previtellogenic stage), further increasing at the early vitellogenic stage, thereafter decreasing to late vitellogenic and migratory nucleus stages. The profiles of both T3 and T4 changed during vitellogenesis, being high during previtellogenic and early vitellogenic stages, and subsequently declining, thus mimicking thyroid gland activity. These results suggest that the thyroid has relation with eel ovarian development during artificial maturation.

EFFECTS OF ACUPUNCTURE ON THE PITUITARYTHYROID AXIS IN RABBITS WITH FRACTURE

PURPOSE: To observe the effects of acupuncture on the pituitary-thyroid axis in rabbits with fracture. METHOD: 36 male rabbits with a 3-mm width experimental defect in the middle segment of the left radius were randomly divided into the treatment group and control group, and the changes in serum T3, T4 and TSH contents in different weeks were investigated. RESULTS: Serum T3, T4 and TSH contents in the treatment group all were higher than those in the control group, with statistically significant differences in the contents of T4 and TSH in the second week and T3 content in the fourth week (P

A CONTROLLED STUDY OF THERAPEUTIC EFFECTS OF COMPUTER-CONTROLLED ELECTRIC ACUPUNCTURE TREATMENT ON REFRACTORY SCHIZOPHRENIA

Out of 100 cases of intractable schizophrenia,57 cases were in the group ofComputer-Controlled Electric Acupuncture (CCEA) and 43 in the control group.The therapeutic re-sults showed that clinically CCEA had a remarkably effective rate of 40. 35% on refractoryschizophrenia,which had much better curative effects than those in the control group.Through dy-namic evaluation of brief psychiatric rating scale (BPRS),negative symptom scale (SANS) and posi-tive symptom scale (SAPS) for both groups before,during and after treatment,the results indicatedthat in CCEA group the scores of BPRS,SANS and SAPS after treatment were much less than thosebefore treatment,which were remarkably different from those in the control group (P【0.01).Lab-oratory examination of thyroxin and androgen of patients in both groups before and after treatmentfound a significant result.

Evaluation of Thyroid Hormones Levels in Libyan Patients with Chronic Renal Failure before and after Maintenance Hemodialy

Data from recent studies revealed that kidney diseases might affect the thyroid function in various ways. A variety of alterations in thyroid hormone levels and metabolism have also been reported in patients with chronic renal failure (CRF) in some studied population. In addition, it was reported that serum levels of both T3 and T4 might alter immediately after a hemodialysis (HD) treatment than before. Therefore, this study was aimed to investigate the level of triiodothyronine (T3) and thyroxine (T4) in CRF Libyan patients before and after HD. This study was carried out on 46 CRF patients (30 males and 16 females) with a mean age of 47.46 ± 15.75 years. These patients were treated at the hemodialysis unit of Educational Central Zelitin Hospital, Zelitin, Libya. None of these patients apparently have any thyroid problems and no history of drug intake that may affect thyroid function. Blood samples were taken from each patient to measure serum levels of T3 and T4, before and after HD. In addition, the effects of several variables including age, gender, body mass index (BMI), presence of both hypertension and, diabetes mellitus and duration of kidney dialysis on serum levels of T3 and T4 before and after HD were also studied. After HD, there was a statistically significant increase in the serum levels of T3, T4. The age, gender, BMI, duration of kidney dialysis and the presence of hypertension and diabetes mellitus did not have any significant effect on the serum level of T3 and T4 before and after HD. However, the serum levels of T3 and T4 were still in the normal range in these examined patients either before or after HD. From these findings, it can be concluded that these CRF patients may be in a euthyroid state, because the serum levels of T3 and T4 were in the normal range. In addition, HD was seemed to improve the T3 and T4 thyroid hormone concentrations, suggesting that HD might activate the secretion of thyroid gland and catabolism. The other variables did not play any role in thyroid hormone levels in these patients either before or after HD. It is highly recommended that large scale evaluation of thyroid hormone levels in Libyan CRF patients is performed by more patients, especially elderly patients.

Effect of estradiol-17β on pituitary-thyroidal axis of Japanese eel (Anguilla japonica)

The effect of estradiol-17β (E2)treatment on the pituitary-thyroidal axis has been investi- gated in female Japanese eels in seawater. The eels were injected with 1 mg/kg body weight (BW) weekly for two to eight weeks; another group was treated with 5 mg/kg BW weekly for eight weeks and sacrificed three days after the last injection. In the pituitary, using RT-PCR systern, the thyroid stim- ulating hormone 3 subunit mRNA (TSHβ MRNA) level is slowly increased in the low-dose E2 treatment group. A significant increase in values occurred after eight weeks E2 injections. The histological structure of the thyroid follicles suggests a hypo-activity as shown by a reduced epithelial cell height in eels injected with E2 after six and eight times, and eventually reached a minimum level after eight weeks. Using ra- dioimmunoassay of thyroxine (T4),triiodothyronine (T3) in the serum, a slowly decrease of both hor- mones is demonstrated. On the other hand, the TSHβ mRNA level is significantly increased from initial in the high-dose E2 treatment group. The histological structure of the thyroid follicles suggests a hypo- activity, and a sharp decrease of the both hormones is also indicated. These data suggest that the expres- sion of TSHβ mRNA level is increased and thyroid hormone release is depressed by E2, the effects de- pend upon E2 inection period and dose. Furthermore, E2 could not directly influence the TSHβ mRNA expression and, TSH transcription might be controlled by a negative feedback of thyroid hormone.

The Reproductive and Thyroid Hormonal Profile of Khat (Catha Edulis) Chewers

The effects of khat on the hormonal levels have been established;however, the effects on human beings are controversial. The aim of our study was to investigate the possible effects of khat on the levels of serum thyroid hormones, testosterone, estradiol (E2), prolactin and cortisol in men. A total of 50 blood samples were collected from healthy males who referred to chew khat for more than 10 years and analyzed for the above hormones. The results were compared to the hormonal levels of 35 non khat chewers. Chewing khat causes significant increases in the testosterone (P < 0.03), prolactin (P < 0.05), E2 (P < 0.00005), FT3 (P < 0.04), and TSH (P < 0.05) levels. No significant differences were found in the serum level of FT4 between the two groups. The level of cortisol were significantly lower (P < 0.001) in the khat chewers group compared to the control group. This study suggests that khat chewing can cause reduction in the cortisol level, which may cause increases of testosterone, prolactin and E2. In addition, chewing khat increases the level of TSH and FT3 serum levels. Therefore, khat may contribute to the relevant disorders caused by abnormal levels of the studied hormones in the people who are chewing

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.