One Case of Acute Fluid Pericarditis and Hyperthyroidism at Teaching Hospital of Bouake (Ivory Coast): Cause-Effect Relationship or Accidental Association?

Cardiovascular complications during hyperthyroidism are dominated by arr-hythmias, heart failure and coronary heart disease. Pericardial effusion which is a common complication of hypothyroidism is extremely rare in hyperthy-roidism. We report the case of a 45-year-old woman admitted for management of pleuro-pericarditis associated with atrial fibrillation in the context of cardiothyreosis. The treatment consisted of a pericardial puncture associated with synthetic anti-thyroid drugs and anti-tuberculosis drugs with positive clinical and echocardiographic outcomes.


Introduction
Pericardial effusions, which are essentially viral origin in industrialized regions, are almost commonly tuberculous in developing countries [1] [2].In addition, during cardiovascular disorders of thyroid origin, pericarditis has often been described in hypothyroidism, while the rhythm and excitability disorders, heart and coronary insufficiency were the prerogative of hyperthyroidism [3].Although rare cases of hyperthyroidism and pericardial effusion have been reported establishing their causal link [4] [5] [6].We report the case of a young DOI: 10.4236/wjcs.2023.139014138 World Journal of Cardiovascular Surgery woman admitted for the management of a pleuro-pericardial effusion in a photo of heart failure, in whom the etiological investigation had revealed hyperthyroidism.Is it a fortitious association or and/or a cause and effect relationship?

Presentation of the Case
A 45-year-old patient who was referred by a Community Health Center to the Cardiology Department of the Teaching Hospital of Bouake for dyspnea that is associated with electrocardiographic abnormalities.The signs have been evolving for a month by the installation of gradually increasing effort dyspnea up to stage 3 of the New York Heart Association associated with medial thoracic pain with posterior irradiation, with a tingling type aggravated by the supine position.
These symptoms were associated with palpitations, a productive cough and seromucous sputum.The evolution would have been marked by the progressive appearance of abdominal distension and edema of the lower limbs in a context of deterioration of the general state without a notion of fever or evening sweats.
The personal and family cardiovascular history was unremarkable and no mention of tuberculosis contagion was found during interrogation.The physical examination at admission revealed an average general impression with a temperature of 37˚C and a skin-mucosal pallor with frank jaundice.The cardiovascular examination was performed in a dyspneic patient with a respiratory rate of 28 cycles/minute, blood pressure of 120/70 mmHg with a heart rate of 125/minute.was marked by the regression of the signs of adiastolia and a spontaneous return to sinus rhythm at electrocardiogram monitoring after three days of treatment.

Discussion
Cardiothyreosis is a form of cardiovascular disease during hyperthyroidism and it is linked to several etiopathogenic entities: multihetero-nodular goiters, Graves' disease, toxic adenoma and thyroid cancer.His best known manifestations are arrhythmias, heart failure and coronary insufficiency, while pericardial effusion has rarely been described [7].Atrial fibrillation is the most common arrhythmia.
Sometimes indicative of hyperthyroidism, it is present in 9% to 22% of cases, compared to 0.4% in the general population [8].Spontaneous return to sinus rhythm during hyperthyroidism correction is common prior to age of 60 in patients without underlying heart disease and whose hyperthyroidism was short-lived.
In contrast, the association of a pleuropericardial effusion with hyperthyroidism is rarely described in the literature, only 18 have been reported since 1958.
Treusch and Jaffe were the first to report three cases of hyperthyroidism associated with acute pericarditis in three women, but they did not provide any definitive conclusion about the association [10].Tourniaire et al. reported two cases of pleuropericarditis that were complicated by tamponade evolving in a febrile context associated with Graves' disease [11].Four cases of pericardial effusion were reported Clarke et al. in middle-aged patients with Basedow's disease [12].
The mechanism of development of a pleuro-pericardial effusion in Basedow's disease remains subject to several hypotheses.Authors stated that the mechanism is similar to that of ophthalmopathy and myxeodema found in hypothyroidism [12] [13].A study of hypothyroidism revealed changes in capillary permeability and extravascular and intravascular protein movement as well as decreased The pathophysiology of hyperthyroidism may be a similar [14].Others authors incriminate an autoimmune mechanism involving direct or indirect interaction with anti-receptor antibodies in the pericardium and pleura [4] [15] [16].The metabolism of pericardial brown fat can be directly affected by thyrotoxicosis [17].The authors suggest performing a thyroid examination in the presence of a pericardial effusion, to detect both hypothyroidism and hyperthyroidism [18].The vital prognosis is at stake, given the risk of tamponade which is added to other serious forms of cardiothyreosis such as arrhythmias.
Teague and O'Brien emphasize that it is crucial to rule out Graves' disease when there is any unexplained pericardial effusion, even if there no signs of thyrotoxicosis.The authors mentioned that a patient on carbimazole and Propranolol for Graves' disease undergoing biological improvement had a pericardial effusion complicated by tamponade [19].In the majority of reported cases, the pleuro-pericardial effusion resolves after treatment of the hyperthyroidism alone [4] [20], but in the cases of tamponade, surgical drainage or pericardiocentesis are necessary.In all cases, it is important to ensure the absence of HIV infection, and to evoke in principle the origin of tuberculosis before a progressive and poorly tolerated pericardial effusion because ECG, radiological and echocardiographic abnormalities are common to abundant pericardial effusions, regardless the etiology [21] [22].

Conclusion
The association of fluid pericarditis and hyperthyroidism is still very uncommon in cardiothyreosis.It must be reviewed and documented to support a causal link between the two.The evolution is generally favorable under synthetic antithyroid treatment while the absence of treatment may engage the prognosis vital by the occurrence of tamponade.
Figure 1.Thoracic X-ray showing cardiomegaly and bilateral fluid pleural effusion.

Figure 2 .
Figure 2. Electrocardiogram showing atrial fibrillation with a rapid ventricular response of between 130 -160 beats per minute, a diffuse undershift of the PQ segment, a diffuse concave ST elevation.