Massive Exudative Pleural Effusion With Hypothyroidism: A Case Report

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.