Refractory Pericardial Effusion Secondary to Central Hypothyroidism due to Empty Sella Syndrome: A Rare Case Report

ABSTRACT Refractory pericardial effusion with a low free T4 but inappropriately normal TSH should prompt evaluation for central hypothyroidism, including pituitary MRI to identify treatable causes such as empty sella syndrome. Glucocorticoid cover must precede levothyroxine to prevent adrenal crisis in patients with possible hypopituitarism.