The occurrence of pericardial effusion during a hypothyroid state is frequent. This clinical evolution justifies the realization of an echocardiographic exam at diagnosis and during follow-up in the management of patient with hypothyroid disease. The pejorative clinical signs of pericardial effusion are relatively rare; the evolution into a pericardial tamponade is not frequently reported. This retrospective report covers the clinical evolution of 3 cases of pericardial tamponade commonly demonstrating a primary hypothyroidy. The echocardiogram allowed for immediate diagnosis of the tamponade; supported by the clinical aspect and the diagnosis of hypothyroidy confirmed biologically. The treatment approach was based on pericardiocentesis of the pericardial effusion associated with progressive hormonotherapy resulting in a favorable clinical outcome and the elimination of the pericardial effusion.