Massive pericardial effusion with cardiac tamponade as initial presentation: Unveiling hypothyroidism

Hypothyroidism is a common condition which is readily diagnosed and managed. It can present with various symptoms including fatigue and weight gain but can rarely present with massive pericardial effusion that may be potentially fatal. A 35-year-old young married female, with prior no comorbid, presented to internal medicine outpatient department (OPD) with gradual onset of shortness of breath for 2 months. Prior to her visit to our OPD, she had been admitted in a tertiary care setup for similar symptoms where on workup she was found to have massive pericardial effusion with cardiac tamponade. On detailed investigation, she had raised thyroid-stimulating hormone. She was started on tablet levothyroxine which improved her symptoms. Despite living in a tuberculosis endemic area, pericardial effusion remains a well-recognized but often underdiagnosed manifestation of hypothyroidism. Very rarely can it present initially as a massive effusion and tamponade requiring urgent intervention.