Cardiac tamponade as the initial presentation of papillary thyroid carcinoma

Hypothyroidism is a well known cause of pericardial effusions and cardiac tamponade; thyroid carcinoma metastatic to the heart and pericardium is rarely encountered in clinical practice. The authors report the case of a 68-year-old male who presented in acute distress from cardiac tamponade. Cytological examination of the pericardial and pleural fluid, and histological examination of a pericardial biopsy revealed a metastatic papillary carcinoma with psammoma bodies. Subsequent reexamination of the patient demonstrated a thyroid nodule and bilateral cervical lymphadenopathy. Fine needle aspiration of the thyroid nodule and cervical lymph nodes detected a papillary thyroid carcinoma with metastases to the lymph nodes. The literature relevant to hypothyroidism, thyroid malignancy and cardiac tamponade is briefly reviewed.