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Hypothyroidism is a common endocrine disorder with potential multi-system involvement. While pericardial effusion may occur in up to 30% of patients with hypothyroidism, cardiac tamponade is rare.We present a case of a woman in her mid 60s who came with complaints of progressive dyspnoea on exertion, apathy, cold intolerance and weight gain. Clinically, she was hypotensive, tachypnoeic and hypoxic but had a normal pulse rate. Echocardiography revealed massive pericardial effusion with cardiac tamponade. She was managed with urgent pericardiocentesis and oral thyroxine replacement.Cardiac tamponade is a medical emergency that necessitates immediate intervention. Our case underscores the need to suspect hypothyroidism as the underlying cause in a patient presenting with cardiac tamponade with a normal heart rate or bradycardia.