A forty five year old lady has come to the medical OPD with a complaint of increasing fatigue, somnolence, constipation and body aches, These symptoms have gradually increased over last two years. Her weight has increased, the menstrual cycle is irregular and has difficulty in hearing. She looks pale, the skin is dry and the voice is hoarse. The pulse is 59/min and regular in character. Blood pressure is 130/80 mm of Hg, Blood sugar is checked and it is 110mg%, CPK (creatinine phospho-kinase) is 1000 ( normal range 100 – 250 ), MCV is 106%. Echocardiography was also done which shows mild pericardial effusion.

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