Sheehan’s syndrome (SS) has been attributed to ischemic damage of the pituitary gland and usually one or more pituitary hormones are involved in different degree [1]. Hormone deficiencies include thyroid hormones in 42%to 53% of patients [2]. Pericardial effusion and tamponade are not infrequent as component of primary hypothyroidism [3,4] but very rare in secondary hypothyroidism [5]. SS with cardiac tamponade (CT) as the initial presenting features has so far not been reported. Fifty-year-old female patient was admitted to our hospital because of dyspnea, fatigue and orthopnea. Detailed post medical history revealed failure of lactation following severe postpartum obstetric hemorrhage twenty years ago. On physical examination, the patient appeared uncomfortable, orthopneic, tachypneic. The pulse rate was 56/min and the blood pressure was 80/65 mm/Hg. Pulsus paradoxus was detected. Biochemical tests were normal except cholesterol: 235 mg/dl and triglycerides: 248 mg/dl. Hormone profile; TSH: 0.791 mIU/ml (0.4–4), Total T3: <40 ng/dl (60–164), Total T4: <1.00 Ag/dl (4.5–12.13), Free T3: 2.08 pg/ml (1.57– 4.71), Free T4: 0.22 ng/dl (0.85–1.78), Cortizol: <1.00 Ag/dl (5–25) (in morning), other hormone parameters were normal. Chest X-ray showed cardiomegaly and low voltage QRS complex seen on electrocardiography. Admission echocardiography showed a massive pericardial effusion, compression of the posterior wall of left ventricle at diastole and late diastolic compression of right atrium and ventricle (Fig. 1). Thorax tomography at admission reported as massive pericardial effusion and atelectasic changes secondary to com-