Severe ascites with hypothyroidism and elevated CA125 concentration: a case report

Myxedema Ascites: A Rare Presentation of Uncontrolled Hypothyroidism

Less than four percent of patients with hypothyroidism develop ascites. Ascites as the presenting feature of hypothyroidism is uncommon, hence diagnosis is often delayed. Once it is diagnosed, treatment of hypothyroidism leads to quick clinical improvement in ascites. We report a case of a female patient who presented with ascites secondary to severe hypothyroidism and discuss the diagnostic characteristics of the ascitic fluid in myxedema ascites on the basis of literature review.

Hypothyroidism Enhanced Portal Hypertension in a Patient with Alcoholic Liver Cirrhosis, Resulting in the Development of Ascites

A man diagnosed with alcoholic liver cirrhosis complained of abdominal distention due to massive ascites. The ascites did not resolve with diuretic agents. The serum-ascites albumin gradient value of 1.9 g/dL and the total protein level in the ascites of 3.1 g/dL indicated the ascites to have been caused by portal hypertension. Hypothyroidism was detected, and the patient received supplementation with levothyroxine. The ascites dramatically decreased after supplementation with levothyroxine. We herein conclude that the ascites in the present case had thus been strongly influenced by portal hypertension, which was induced by liver dysfunction associated with liver cirrhosis and hypothyroidism.

Respiratory failure with myxedema ascites in a patient with idiopathic myxedema

Here we report the case of a 50-year-old woman presenting with weight gain, whole-body edema, and massive ascites. Blood examination revealed primary hypothyroidism with TSH-blocking antibody, and the echocardiogram showed diffuse hypokinesis of the left ventricle with pericardial effusion. Although she received thyroid hormone replacement therapy immediately, her ascites increased and she developed type II respiratory failure requiring transient noninvasive positive pressure ventilation (NIPPV). She recovered following the temporary drainage of the ascites, administration of diuretics, and continuous thyroid hormone replacement. The amount of ascites decreased during therapy, along with an increase in thyroid hormone levels. Finally, the ascites disappeared completely, followed by the normalization of the cardiac wall motion. Herein we report this rare case in detail, and also discuss the mechanism by which primary hypothyroidism induced such severe conditions in our patient.