# Massive Exudative Pleural Effusion With Hypothyroidism: A Case Report

## TL;DR

A 79-year-old woman developed severe fluid buildup in her chest and around her heart due to untreated hypothyroidism, which improved after restarting thyroid hormone therapy and drainage.

## Contribution

This case highlights the rare but severe complications of untreated hypothyroidism, including massive pleural effusion requiring drainage.

## Key findings

- Severe exudative pleural effusion and pericardial effusion occurred due to prolonged hypothyroidism.
- Thyroid hormone replacement therapy improved pericardial effusion and ascites without drainage.
- Drainage was necessary for severe pleural effusion unresponsive to diuretics.

## Abstract

Here, we report the case of a 79-year-old woman with massive exudative pleural effusion and hypothyroidism. The patient underwent total thyroid and parathyroidectomy during pharyngoesophagectomy for hypopharyngeal cancer. She was administered a thyroid hormone preparation (87.5 μg of levothyroxine sodium), calcium supplementation (0.5 g of calcium lactate hydrate), and active vitamin D (2 g of alfacalcidol). Four months after missing her regular medical appointment and discontinuing her medications, she developed a severe exudative pleural effusion, circumferential pericardial effusion, and mild ascites secondary to hypothyroidism. The pleural effusion, which may have been exacerbated by prolonged hypothyroidism and associated heart failure, improved with drainage and did not recur after the initiation of thyroid hormone replacement therapy. The pericardial effusion and ascites improved with hormone replacement alone. Although fluid retention associated with hypothyroidism usually improves with thyroid hormone therapy, drainage may be required to treat severe exudative effusions in diverse body cavities when diuretic treatments are insufficient.