Ann Pediatr Endocrinol Metab.  2015 Jun;20(2):98-101. 10.6065/apem.2015.20.2.98.

Massive pericardial effusion and short stature caused by autoimmune hypothyroidism in a 9-year-old girl

• Gyon YH
• Han HS

• KMID: 2368993
• DOI: http://doi.org/10.6065/apem.2015.20.2.98

Abstract

A 9-year-, 11-month-old girl was brought to the Emergency Department for sudden dyspnea caused by massive pericardial effusion. In addition to relative bradycardia despite impending cardiac tamponade, short stature, overweight, and hypercholesterolemia were clues for suspected hypothyroidism. During thyroxine supplementation, catch-up growth was incomplete by rapid skeletal maturation. The use of short-term growth hormone showed increased growth velocity. In conclusion, primary hypothyroidism should be included in the etiologic evaluation of pericardial effusion, especially when it is associated with relative bradycardia. Additional growth promoting therapy should be considered for incomplete catch-up growth in prolonged hypothyroidism during thyroxine supplementation.

Keyword

Hypothyroidism; Cardiac tamponade; Bradycardia; Growth; Hypercholesterolemia

MeSH Terms

Bradycardia
Cardiac Tamponade
Child*
Dyspnea
Emergency Service, Hospital
Female
Growth Hormone
Humans
Hypercholesterolemia
Hypothyroidism*
Infant
Overweight
Pericardial Effusion*
Thyroxine
Growth Hormone
Thyroxine

Figure

• 

  Fig. 1 Echocardiography revealed massive pericardial effusion around the heart and fluctuating mitral inflow pattern recorded according to respiration (A), and closed pericardiostomy was performed with pericardial catheter (B).

• 

  Fig. 2 Thyroid ultrasonography showed mild heterogeneous echogenicity without intrathyroid nodule and lymph node enlargement (A), and thyroid 99mTc scintigram showed focal increase of radio-uptake in right lobe and nearly non-visualization of left lobe (B).

• 

  Fig. 3 Height standard deviation score (HSDS) improved during 1st year of thyroxine (T4) replacement with appropriate bone age (BA) progression. But during next 6 months, BA progressed rapidly without improvement of HSDS. Growth hormone was tried for the next 6 months with remarkable increase of HSDS. BMI, body mass index; CA, chronologic age.

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