Hypothyroidism can cause respiratory failure associated with hypoventilation and sleep apnea syndrome. Here, we report
the case of a 59-year-old woman presenting with weight gain, whole-body edema and dyspnea. On admission in emergency
department, she had type II acute respiratory failure. Blood examination revealed hypothyroidism with an elevated TSH
level: 55.24 μIU/mL and a very low level of Free T4: 1.21 ng/L. A chest X ray showed cardiomegaly and the echocardiogram
showed diffuse hypokinesis. She immediately received thyroid hormone with steroid substitution therapy along with noninvasive
positive pressure ventilation (NIPPV).