Grade IIII cardiomegaly

A 42-year-old patient arrives at the clinic and complains of hypersomnia, nasal blockage, and snores that have worsened over the past three months. He mentioned high-effort dyspnea, bradylalia, dry skin, cold intolerance, and constipation. Grade IIII cardiomegaly and a suggestive water bottle image were found on the chest X-ray. A right-axis deviation was seen on the EKG. The following values were obtained from thyroid function tests: TSH was 73.45 uUI/mL, T4T was 1.48 ug/dL, T4L was 0.08 ng/dL, T3T was 0.91 ng/dL, and T3L was 2.51/mL. Transthoracic echocardiography revealed enlarged right atria, right ventricle hypertrophy, normal left ventricular systolic and diastolic function, 68% right ventricle ejection fraction, preserved right ventricle systolic function, and 1264 ml of pericardial effusion without cardiac tamponade.