Pericardial disease associated with Grave's thyrotoxicosis.

Sir, Cardiac complications may dominate the clinical picture in the middle‐aged and older patient with thyrotoxicosis. A cardiomyopathy with poor resting systolic function, which may or may not be reversible following return to the euthyroid state, has occasionally been described.1,,2 Other poorly‐understood complications include atrioventricular block and acute ischaemic syndromes, including myocardial infarction in the absence of coronary disease. Transient widespread ST/T wave changes and atrial fibrillation are common in hyperthyroidism. We suggest that pericardial disease may be an unrecognized complication of hyperthyroidism. Patient 1, a 53‐year‐old man, presented with clinical features of cardiac tamponade and a pyrexia of 38 °C. Following drainage of a large bloodstained pericardial effusion, a CT scan demonstrated marked thickening of the visceral and parietal pericardium, and cardiac catheterization revealed pericardial constriction. Thyrotoxicosis was suggested by a history of a recent tendency to anxiety and heat intolerance. Carbimazole was commenced in addition to frusemide following biochemical confirmation, and euthyroidism was restored after 2 months. He later underwent successful pericardectomy. Patient 2, a …