This case study presents a 60-year-old female with a complex medical history, including COPD, hypertension, and hypothyroidism, who presents to the emergency department with acute onset shortness of breath. The case details the patient's presentation, including symptoms of dyspnea, fatigue, and new-onset edema. The initial evaluation includes a physical exam, vital signs, and various diagnostic tests such as CBC, CMP, arterial blood gas, ECG, and chest X-ray, which reveal findings consistent with respiratory distress, possible acute renal injury, and cardiomegaly. The differential diagnosis includes COPD exacerbation, congestive heart failure, and myxedema coma. Subsequent evaluations, including TSH, free T4, BNP, CT scan of the chest, and echocardiogram, lead to a diagnosis of myxedema coma, pericardial effusion, and COPD exacerbation. The management of the patient involves intubation, thyroid hormone supplementation, fluid resuscitation, and vasopressor support in the ICU. The case highlights the challenges of managing a patient with multiple comorbidities and the importance of prompt diagnosis and treatment in critical care settings. The patient's poor medication compliance further complicated the case.