PMC9758553_01
Graph (1) showed serial thyroid function tests for Case 1 at baseline and during course of treatment and graph (2) showed serial thyroid function tests for Case 2 at baseline and during course of treatment.
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Her TSH decreased by half to 49.92 mIU/L (0.55-4.78 mIU/L), with FT4 of 8.3 pmol/L (11.5-22.7 pmol/L) after two days of combination therapy of levothyroxine and liothyronine, which subsequently normalized after one week of treatment, with TSH 4.65 mIU/L, FT4 of 10 pmol/L (Figure 1).
(A) PA erect chest radiography of Case 1 demonstrating cardiac shadow with globular appearance. (B) Chest radiography revealing reduction in cardio-thoracic ratio post commencement of thyroxine replacement therapy.
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Repeated chest radiograph and electrocardiogram showed marked improvement post thyroxine hormone replacement therapy (Figures 2 and 3).
(A) Electrocardiogram of Case 1 upon presentation revealing low voltage QRS complexes. (B) Electrocardiogram of Case 1 post thyroid hormone replacement therapy.
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Repeated chest radiograph and electrocardiogram showed marked improvement post thyroxine hormone replacement therapy (Figures 2 and 3).
PMC9758553_02
Graph (1) showed serial thyroid function tests for Case 1 at baseline and during course of treatment and graph (2) showed serial thyroid function tests for Case 2 at baseline and during course of treatment.
JAFES-37-2-106-g001.jpg
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Her TSH decreased by half to 49.92 mIU/L (0.55-4.78 mIU/L), with FT4 of 8.3 pmol/L (11.5-22.7 pmol/L) after two days of combination therapy of levothyroxine and liothyronine, which subsequently normalized after one week of treatment, with TSH 4.65 mIU/L, FT4 of 10 pmol/L (Figure 1).
(A) Chest radiograph of Case 2 showing cardiomegaly with globular enlargement. (B) Chest radiograph post pericardiocentesis showing resolution of pericardial effusion.
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Chest radiograph showed massive cardiomegaly (Figure 4).
(A) Transthoracic echocardiogram parasternal long axis view of Case 2 demonstrating pericardiac effusion of 3.96 cm. (B) Transthoracic echocardiogram parasternal long axis view showing reduction in pericardial effusion size.
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Echocardiogram revealed large global pericardial effusion ranging from 1.2-3.9 cm but no collapse of right ventricular free wall in diastole with left ejection fraction of 65 % (Figure 5). Echocardiogram reassessment post tapping showed more than 50% reduction of pericardial effusion, ranging from 5-9 mm, no right ventricular chamber collapse during diastole, with ejection fraction of 69% (Figure 5).