The cause of pleuropericardial effusion can be varied and includes many differential diagnoses. One of the very rare causes of pleuropericardial effusion can be hypothyroidism. The clinical findings of hypothyroidism are generally subtly leading to delay in diagnosis. We present a case of a middle-aged patient who presented at our tertiary care center with massive pleuropericardial effusion due to hypothyroidism which was managed conservatively. Hypothyroidism can present as pleuropericardial effusion and the treating physician should keep that differential while evaluating and treating such cases.
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