When hyperthyroidism goes unchecked: A rare case of cardiac tamponade induced by acute pericarditis in Graves’ disease

Abstract

Graves’ disease, the most prevalent cause of hyperthyroidism, is an autoimmune disorder associated with several cardiovascular complications. The occurrence of acute pericarditis within the context of Graves’ disease, is very rare. We present an uncommon case of cardiac tamponade in a patient diagnosed with Graves’ disease. A female patient, was admitted with symptoms of dyspnea and palpitations. Clinical examination revealed Beck's triad. Transthoracic echocardiography showed a large pericardial effusion with significative respiratory variations, indicating an urgent pericardiocentesis. Thyroid function tests revealed hyperthyroidism with positive TSH-receptor antibodies, and elevated anti-TPO antibodies. Cardiac tamponade, induced by acute pericarditis in Graves’ disease is an uncommon entity. Typically, the diagnosis is established on a detailed history and physical examination, supported by specific investigations, including suppressed levels of TSH along with elevated free T4 levels and thyroid receptor antibodies. Pericardiocentesis, NSAIDs, betablockers, associated with antithyroid medications constitute the mainstay of treatment.