SHM Converge Scientific Abstract ePoster Gallery-Pericardial Effusion Secondary to Graves' Disease in a Pediatric Patient

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A 12-year-old girl presented with 1.5 weeks of nighttime, non-exertional chest pain and shortness of breath, worsened by position changes and associated with nausea, shallow breathing, and subjective fever. Initial chest x-ray was normal, but EKG showed sinus tachycardia. Repeat EKG demonstrated diffuse ST elevations and PR depression, consistent with pericarditis, and echocardiogram revealed a small posterior pericardial effusion.  <br /><br />She was admitted and found to have thyrotoxicosis with suppressed TSH and elevated free T4, later confirmed as Graves’ disease with elevated thyroid-stimulating immunoglobulin. On exam, she had tachycardia and a palpable 5 cm homogeneous goiter, but no exophthalmos. She was started on propranolol and methimazole and discharged.  <br /><br />The night after discharge, she returned with worsening sharp chest pain unresponsive to ibuprofen. In the emergency department, labs again showed severe hyperthyroidism and elevated troponin. Transthoracic echocardiogram now demonstrated a large circumferential pericardial effusion with early tamponade, while left ventricular function remained normal. She was transferred to the PICU and underwent emergent pericardiocentesis and pericardial drain placement. She also received a brief steroid course, methimazole, potassium iodide, and NSAIDs.  <br /><br />Three weeks later, she was asymptomatic with no recurrent pericarditis or pericardial effusion.  <br /><br />This case highlights that pericarditis and pericardial effusion, though more commonly linked to hypothyroidism, can occur as complications of hyperthyroidism and Graves’ disease, even in pediatric patients. Early recognition of thyrotoxicosis in patients with chest pain or pericardial disease is important to prevent severe complications such as tamponade.

Asset Subtitle

Kelly Robinson

Meta Tag

Author List Kelly Robinson, Sahit N. Menon, Tiranun Rungvivatjarus

Category Clinical Vignettes

Concept Thyroid Dysfunction

Concept Pericarditis

Concept Pericardial Effusion

Concept Graves Disease

Concept Hyperthyroidism

Distinguished Non-Finalist

Presenter Organization Ucsd

Presenting Author Kelly Robinson

Track Pediatric

Keywords

pericarditis

pericardial effusion

Graves disease

thyrotoxicosis

hyperthyroidism

cardiac tamponade

pediatric patient

chest pain

pericardiocentesis

diffuse ST elevations

Thyroid Dysfunction

Pericarditis

Pericardial Effusion

Graves Disease

Hyperthyroidism