Figure 3:  .

Sequential chest x rays from a patient with longstanding hypothyroidism that was complicated by congestive cardiac failure. (A) Before treatment. Cardiomegaly was caused by a combination of dilatation of all the cardiac chambers and pericardial effusion. (B) After treatment with thyroxine for nine months. (C) Seven years later, two years after the patient has stopped taking thyroxine, against medical advice, and had re-presented to the same physician with the symptoms and signs of heart failure. Reproduced from Davidson's principles and practice of medicine, 18th ed, p 570, with permission of the publisher Churchill Livingstone.