Chylous Ascites as a Manifestation of Thyrotoxic Cardiomyopathy in a Patient with Untreated Graves' Disease

Hsieh, Min-Huang; Chen, Ching‐Chu; Wang, Tzu-Yuan; Chang, Chwen‐Tzuei

doi:10.1089/thy.2010.0020

Cited by 6 publications

(15 citation statements)

References 11 publications

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“…Even among patients with CA, SAAG was reported to be effective in distinguishing ascites caused by portal hypertension from ascites due to other etiologies (2-4). In our case, an analysis of the ascitic fluid revealed an elevated SAAG (2.0 g/dL) and protein level (3.1 mg/dL), compatible with the diagnosis of portal hypertension secondary to heart failure; notably, other findings of In addition to the findings of the present case, we reviewed the analytical findings of ascites from the six previously reported cases of CA with heart failure (Table 3) (5,(7)(8)(9)(10)(11). Among these 7 cases, SAAG was described in 5 cases, including 4 with an SAAG !…”

Section: Discussionsupporting

confidence: 68%

“…Excluding cases with constrictive pericarditis, only six cases of CA associated with heart failure have been reported (5,(7)(8)(9)(10)(11). Some pathophysiological hypotheses have been proposed.…”

Section: Discussionmentioning

confidence: 99%

“…The underlying etiologies for CA have been classified as traumatic, congenital, infectious, neoplastic, postoperative, cirrhotic, and cardiogenic (2)(3)(4). Hyperthyroidism might be associated with the development of CA, and only two such cases have been reported in the literature (5,6). Furthermore, heart failure has been reported as a reversible cause of CA (5,(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

“…Hyperthyroidism might be associated with the development of CA, and only two such cases have been reported in the literature (5,6). Furthermore, heart failure has been reported as a reversible cause of CA (5,(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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Chylous Ascites Due to Hyperthyroidism and Heart Failure

Uchihara

Ehara²,

Iwanami³

et al. 2022

Intern. Med.

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Chylous ascites (CA) is the accumulation of fluid with a high triglyceride content in the peritoneal cavity. Only two cases in the literature have reported CA with hyperthyroidism. A 28-year-old previously healthy woman presented with gradual-onset abdominal swelling, exertional dyspnea, and diarrhea. Hyperthyroidism and heart failure were diagnosed using laboratory investigation and echocardiography. Ultrasonography revealed a large amount of ascites. The ascitic fluid was milky with elevated triglyceride levels. Treatment with anti-thyroid therapy and diuretics improved all symptoms, and the free triiodothyronine (T3) level normalized after five days. Hyperthyroidism and heart failure should be considered as reversible causes of CA.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Chylous Ascites Due to Hyperthyroidism and Heart Failure

Uchihara

Ehara²,

Iwanami³

et al. 2022

Intern. Med.

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“…Congestive heart failure can also cause CA by increasing formation of and impaired lymphatic drainage [ 12 , 42 , 43 ]. CA may develop as a result of heart failure secondary to thyrotoxic cardiomyopathy and resolve promptly if treated appropriately [ 44 ]. The nephrotic syndrome has been reported for unknown mechanism to cause chylous effusions including CA [ 45 , 46 ].…”

Section: Etiologymentioning

confidence: 99%

Chylous Ascites: Evaluation and Management

et al. 2014

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Chylous ascites refers to the accumulation of lipid-rich lymph in the peritoneal cavity due to disruption of the lymphatic system secondary to traumatic injury or obstruction. Worldwide, abdominal malignancy, cirrhosis, and tuberculosis are the commonest causes of CA in adults, the latter being most prevalent in developing countries, whereas congenital abnormalities of the lymphatic system and trauma are commonest in children. The presence of a milky, creamy appearing ascitic fluid with triglyceride content above 200 mg/dL is diagnostic, and, in the majority of cases, unless there is a strong suspicion of malignancy, further investigations are not required in patients with cirrhosis. If an underlying cause is identified, targeted therapy is possible, but most cases will be treated conservatively, with dietary support including high-protein and low-fat diets supplemented with medium-chain triglycerides, therapeutic paracentesis, total parenteral nutrition, and somatostatins. Rarely, resistant cases have been treated by transjugular intrahepatic portosystemic shunt, surgical exploration, or peritoneovenous shunt.

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Pleuropericardial Compromise Associated With Graves’ Disease: A Systematic Review

et al. 2022

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Graves' disease (GD) is the main cause of hyperthyroidism. Cardiovascular complications of GD may have a delayed onset, accompanied by pericardial and pleural inflammation or inflammatory effusions. Pleuropericardial compromise (PPC) associated with GD is a rare disorder. It is postulated that the pathophysiology may involve an interaction between antithyroid antibodies and pericardium. Currently, there is no guideline for the treatment of GD-induced serositis. We conducted a systematic review to compare similar PPCs in GD reports. This article aimed to summarize the information to understand physiopathology and propose preliminary management. A total of 14 articles describing 16 cases of serositis induced by GD were selected. The characteristics of the pleural and pericardial fluid express the inflammatory nature of GD and facilitate the diagnosis. Imaging methods, mainly ultrasound (US), chest X-ray, and computed tomography (CT), contribute to the diagnosis of PPC. Treatment of GD could be the cornerstone in the management of this entity, adding radioactive iodine as a definitive therapy if the patient does not reach a euthyroid state with antithyroid drugs.

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Chylous Ascites as a Manifestation of Thyrotoxic Cardiomyopathy in a Patient with Untreated Graves' Disease

Abstract: Chylous ascites may develop as a result of heart failure secondary to thyrotoxic cardiomyopathy and resolve promptly if treated appropriately.

Cited by 6 publications

References 11 publications

Chylous Ascites Due to Hyperthyroidism and Heart Failure

Chylous Ascites Due to Hyperthyroidism and Heart Failure

Chylous Ascites: Evaluation and Management

Pleuropericardial Compromise Associated With Graves’ Disease: A Systematic Review

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