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Heart failure (HF) is the final common pathway of many cardiovascular diseases. Although the most common cause of heart failure is ischemic heart disease, other less common causes such as thyrotoxicosis, beri beri, anaemia should be considered during management to improve overall outcome. Hyperthyroidism is a potentially reversible cause of heart failure resulting in complete cure if managed appropriately. Here we report an interesting case of cardiac failure with severe atrial fibrillation which turned out to be an undiagnosed case of primary thyrotoxicosis. This case report highlights the fact that every patient with heart failure should be evaluated for thyrotoxicosis as a cause especially in the absence of coronary artery disease and other structural heart diseases. Further, small diffuse goitres especially in obese women with short neck may be missed during routine clinical examination and use of ultrasound early will help in clinching the diagnosis.