Thyroid Disease and Echocardiography

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Hypothyroidism and hyperthyroidism are both associated with clinically significant cardiovascular derangements. In hypothyroidism, these include pericardial effusion, heart failure, and the complex interrelationship between hypothyroidism and ischemic heart disease. Cardiovascular disorders associated with hyperthyroidism include atrial tachyarrhythmias, mitral valve dysfunction, and heart failure. Although these usually occur in individuals with intrinsic heart disease, thyroid dysfunction alone rarely causes serious but reversible cardiovascular dysfunction. (1)

In hypothyroidism a measurable abnormality of the left ventricle is the lengthened duration of contraction and relaxation, normalizing after restoration of euthyroidism. The ejection fraction and cardiac reserve are only slightly diminished. There is reversible diastolic dysfunction. Diastolic hypertension due to hypothyroidism is the most frequent cause of endocrine hypertension. The relation between accelerated atherosclerosis and hypothyroidism is not definitively proven.(2)

Hypothyroidism produces a decrease in myocardial contractility and an increase in left ventricular mass, both related to the severity of hormone deficiency. Pericardial effusion is mainly related to thyrotrophin plasma levels. Most of cardiac manifestations of hypothyroidism reverse with thyroid replacement. (3)

Substernal goiters rarely cause pericardial effusions.(4)

Pericardial effusion is reported to occur in 30% to 80% of subjects with hypothyroidism. However, these earlier studies were conducted when the diagnosis of hypothyroidism was only suspected and was confirmed only in the presence of classic clinical features. In contrast, the diagnosis has recently been established in the early mild stage or more often in an asymptomatic stage because of more frequent or routine determinations of thyroid function tests, especially in the elderly. Thus, the subjects in the older studies were severely hypothyroid at the time of diagnosis and may not be representative of the present hypothyroid population. For this reason, 30 subjects with hypothyroidism were evaluated with echocardiography to reassess the evidence of pericardial effusion in this disorder. Only two subjects demonstrated pericardial effusion, and in only one of them with severe disease could the pericardial effusion be attributed to hypothyroidism, since it resolved on the patient's attaining the euthyroid state. Thus the incidence of pericardial effusion was only 3% to 6%, depending on the inclusion of one or both subjects, an extremely infrequent occurrence when compared with that of previous studies. Moreover, the occurrence of pericardial effusion in hypothyroidism appears to be dependent on the severity of the disease. Thus pericardial effusion may be a frequent manifestation in myxedema, an advanced severe stage, as previously found, but a rare association of hypothyroidism, an early mild stage, because of the timeliness with which the latter condition is nowadays detected. (5)


  1. Ladenson PW. Recognition and management of cardiovascular disease related to thyroid dysfunction. Am J Med 1990 Jun;88(6):638-41
  2. Tielens E, Visser TJ, Hennemann G, Berghout A. Cardiovascular effects of hypothyroidism. Ned Tijdschr Geneeskd. 2000 Apr 8;144(15):703-6.
  3. Gonzalez Vilchez F, Castillo L, Pi J, Ruiz E. Cardiac manifestations of primary hypothyroidism. Determinant factors and treatment response. Rev Esp Cardiol. 1998 Nov;51(11):893-900
  4. Anders HJ. Compression syndromes caused by substernal goitres. Postgrad Med J. 1998 Jun;74(872):327-9.
  5. Kabadi UM, Kumar SP. Pericardial effusion in primary hypothyroidism. Am Heart J. 1990 Dec;120(6 Pt 1):1393-5.

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