Cardiac tamponade in myxedema

Pericardial effusions are frequently found in myxedema and , when present, are asymptomatic and usually of no hemodynamic consequence. We report a patient with ascites and pericardial effusion due to myxedema who developed cardiac tamponade following abdominal paracentesis. This case emphasizes that treatment of patients with myxedematous chronic pericardial effusions should include avoidance of those measurements which may reduce venous filling pressure or effective cardiac output regardless of the thyroid status.