Introduction: The most frequent causes of polyserositis include neoplasia, autoimmune diseases, and infections. Polyserositis, an uncommon feature of disseminated tuberculosis (TB), may delay diagnosis of TB. Patients with hypothyroidism have a higher risk of developing tuberculosis compared to those without hypothyroidism.

Case presentation: Here, we report the case of a 32-year-old female patient who presented with a complaint of abdominal distension of 3 weeks associated with shortness of breath and excessive fatigue. Thyroid function tests were suggestive of primary hypothyroidism and sputum GeneXpert was positive for tuberculosis with exudative pleural effusion. The polyserositis resolved following the initiation of levothyroxine and anti-tuberculosis drugs.

Conclusion: Polyserositis is extremely rare in patients with primary hypothyroidism and it is uncommon presentation of tuberculosis. Evaluation for tuberculosis should be the rule for any patient presenting with polyserositis, especially in high tuberculosis burden countries.

Keywords: Polyserositis, Hypothyroidism, Tuberculosis