TITLE:
Cardiac Tamponade as Initial Presentation of Hypothyroidism: A Case Report from Sub-Saharan Africa
AUTHORS:
Solange Flore Mongo Ngamami, Rogue Pattern Bakekolo, Eric Gibrel Kimbally-Kaky, Kivie Moue-Moue Ngolo Letomo, Christian Michel Kouala Landa, Franck Yannis Kouikani, Bertrand Fikahem Ellenga Mbolla
KEYWORDS:
Cardiac Tamponade, Hypothyroidism, Myxedema, Pericardial Effusion, Sub-Saharan Africa, Thyroid Hormone Replacement Therapy
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.15 No.10,
October
30,
2025
ABSTRACT: Background: Cardiac tamponade secondary to hypothyroidism is a rare but life-threatening complication. A recent systematic review identified 47 cases worldwide between 2000 and 2023, with none reported from Sub-Saharan Africa, highlighting the significant underreporting of this condition in the region. Early recognition is crucial for favorable outcomes in resource-limited settings. Case Presentation: A 50-year-old Congolese woman presented with a 4-month history of progressive dyspnea, anasarca, and intellectual slowness. Clinical examination revealed signs of cardiac tamponade with massive pericardial effusion (45 mm) confirmed by echocardiography. Laboratory investigations demonstrated severe hypothyroidism (TSH: 75.72 mU/L, free T4: 0.5 pg/mL). Emergency pericardiocentesis yielded 1,950 mL of exudative fluid. Levothyroxine replacement therapy was initiated and gradually titrated. Complete resolution of effusions and hemodynamic improvement were achieved at 3-month follow-up. Conclusion: Hypothyroid cardiac tamponade, though rare, should be systematically considered in middle-aged women with unexplained pericardial disease in Sub-Saharan Africa. Combined surgical-medical management ensures excellent outcomes when diagnosed early.