Pleural effusion as an initial clinical presentation of myxedema: report of a case

Myxedema causes functional derangement of various organs. However, it is rarely presented by pleural effusion. A 71-year-old man who had received radiotherapy for his nasal malignancy and left mandibular tumor developed bilateral, massive, refractory pleural effusions and respiratory embarrassment with several episodes of apnea in spite of treatment with diuretics, antibiotics, antituberculous agents, adrenal corticosteroid hormone and therapeutic thoracenteses. Definitive diagnosis was delayed until 6 months after admission. Replacement of the thyroid hormone resulted in the disappearance of the pleural effusion and the dramatic improvement of his long-time hearing impairment. Myxedema should be considered in the differential diagnosis of an unexplained pleural effusion no matter whether it is a transudate or an exudate.