Severe Ascites with Hypothyroidism and Elevated CA125 Concentration: A Case Report

Kimura, Ryosuke; Imaeda, Kazuo; Mizuno, Tatsuo; Wakami, Kazuko; Yamada, Kazuhiro; Okayama, Naotsuka; Kamiya, Y.; Joh, Takashi

doi:10.1507/endocrj.k06-139

Cited by 7 publications

(19 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A ascite causada por hipotireoidismo é uma condição rara e sua causa ainda não está bem definida [1][2][3] . A primeira descrição de ascite com hipotireoidismo foi feita por Kocher em 1883 e descrita por Paddock num relato de caso de uma ascite grave com mixedema 1 .…”

Section: Discussionunclassified

“…Hipotireoidismo primário é uma desordem endócrina relativamente comum, caracterizada por deficiência do hormônio da tireóide, cujas manifestações clínicas resultam da redução da atividade metabólica 1,2 . A evolução clínica do hipotireoidismo geralmente é insidiosa e os sintomas podem ser sugestivas de outras…”

Section: Discussionunclassified

“…Med. UFPR 3(2):88-90 90 doenças 4 .Dessa forma, o diagnóstico pode ser ocasionalmente complexo quando não há sintomas específicos 2,4 .…”

Section: Discussionunclassified

“…O hipotireoidismo induz mudança na dinâmica cardiovascular, portanto derrame pericárdico e pleural ocorrem frequentemente 1,2,4 .…”

Section: Discussionunclassified

“…A ascite causada por hipotireoidismo é uma condição rara e sua causa ainda não está bem definida [1][2][3][4][5] . Uma hipótese proposta é o aumento da permeabilidade capilar causada por baixos níveis de hormônios tireoidianos 2 .Quando causas comuns de ascite forem excluídas, a possibilidade de ascite mixedematosa deve ser considerada e a função tireoidiana deve ser avaliada 3 .…”

Section: Introductionunclassified

See 4 more Smart Citations

Uma Causa Incomum De Ascite

Longo¹,

Corrêa²,

Laganá³

et al. 2016

Rev. Med. UFPR

View full text Add to dashboard Cite

RESUMOIntrodução: A ascite causada por hipotireoidismo é uma condição rara e sua causa ainda não está bem definida. Quando causas comuns de ascite forem excluídas, a possibilidade de ascite mixedematosa deve ser considerada e a função tireoidiana deve ser avaliada. Objetivo: relatar um caso de ascite mixedematosa. Relato de caso: Paciente feminina, 57 anos, encaminhada para abordagem cirúrgica de prolapso retal e uterino. No internamento, observada ascite volumosa e iniciada investigação etiológica. Constatado GASA de 2 e descartadas outras causas de ascite por exames complementares, foram solicitados exames laboratoriais para avaliação da função tireoidiana, cujos resultados foram compatíveis com hipotireoidismo (TSH >100 Ui/ml e T4L <0.4 ng/dl). Foi iniciado tratamento com levotiroxina e a paciente recebeu alta com normalização da função tireoidiana e evidente melhora da ascite. Conclusão: Em caso de ascite mixedematosa, haverá uma resposta importante após o tratamento do hipotireoidismo somente. A resposta ao uso de levotiroxina confirma a etiologia da ascite secundária ao hipotireoidismo.Descritores: hipotireoidismo, ascite e ascite mixedematosa ABSTRACT Introduction: Ascites caused by hypothyroidism is a rare condition and its cause is not well defined. When common causes of ascites are excluded, the possibility of myxedema ascites should be considered and thyroid function should be assessed. Objective: To report a case of myxedema ascites. Case report: A female patient, 57 years old, was referred for surgical treatment of rectal and uterine prolapse. In the hospital, we observed large ascites and started etiological investigation. A SAAG of 2 was observed, and common causes of ascites had been ruled out through complimentary exams. Laboratory tests were requested to evaluate thyroid function and the results were consistent with hypothyroidism (TSH >100 UI/ml and fT4 <0.4 ng/dl). Treatment was started with levothyroxine and the patient was discharged with normalization of thyroid function and great improvement of ascites. Conclusion: In case of myxedema ascites, there will be an important improvement after adequate treatment. The impressive response to the use of levothyroxine confirms the etiology of ascites secondary to hypothyroidism.

show abstract

Section: Discussionunclassified

“…Med. UFPR 3(2):88-90 90 doenças 4 .Dessa forma, o diagnóstico pode ser ocasionalmente complexo quando não há sintomas específicos 2,4 .…”

Section: Discussionunclassified

“…O hipotireoidismo induz mudança na dinâmica cardiovascular, portanto derrame pericárdico e pleural ocorrem frequentemente 1,2,4 .…”

Section: Discussionunclassified

Section: Introductionunclassified

See 3 more Smart Citations

Uma Causa Incomum De Ascite

Longo¹,

Corrêa²,

Laganá³

et al. 2016

Rev. Med. UFPR

View full text Add to dashboard Cite

show abstract

Myxedema ascites? A rare presentation of ascites in severe hypothyroidism: A case report and review

Konar,

Pillay,

Sookdev

2024

SAGE Open Medical Case Reports

View full text Add to dashboard Cite

Ascites represents an infrequent sequela of hypothyroidism, manifesting in fewer than 4% of affected individuals. Herein, we delineate a case characterized by profound hypothyroidism accompanied by substantial ascites, further complicated by cardiac insufficiency. A 29-year-old female, previously diagnosed with postradiation hypothyroidism subsequent to a diagnosis of Grave’s disease 11 years prior, presented with exacerbating dyspnoea, abdominal distension, and orthopnea. In January 2024, she was admitted with massive ascites, exhibiting clinical manifestations of both hypothyroidism and cardiac failure. Thyroid function tests were markedly abnormal, with a thyroid-stimulating hormone level of 77.65 mIU/L, triiodothyronine at 2.2 nmol/L, and thyroxine levels below 3.2 pmol/L. Echocardiographic evaluation revealed dilated cardiomyopathy with a significantly reduced systolic (ejection fraction of 25.9%) and diastolic function (E/A ratio of 0.87). Analysis of the ascitic fluid demonstrated a serum-ascites albumin gradient exceeding 1.1 g/L (3 g/L). Ultrasonography of the abdomen ruled out portal hypertension, while computed tomography of the abdomen confirmed extensive ascites without evidence of malignancy. Under the supervision of a specialist, the patient was administered a high dosage of levothyroxine (300 mcg), leading to a significant amelioration in both thyroid function parameters and her ascites. Subsequent thyroid function tests demonstrated a decrease in thyroid-stimulating hormone levels to 11.7 mIU/L and an increase in thyroxine levels to 15.6 pmol/L, indicating a positive response to the thyroid hormone replacement therapy. Subsequent echocardiographic assessment showed improvement in the ejection fraction to 26.9% and diastolic function (E/A ratio of 1.27). Myxedema ascites, though infrequent, is readily amenable to treatment. The serum-ascites albumin gradient exceeding 1.1 g/L may be indicative of hypothyroidism-associated ascites, although the paucity of studies renders it uncertain whether this is a characteristic feature. Further investigation into the etiology, diagnostic criteria, and management strategies for ascites in the context of hypothyroidism is warranted.

show abstract

Myxoedema ascites-Rare presentation of long standing hashimotos thyroiditis

Sharma¹,

Shah

Shah³

2021

IJIRM

View full text Add to dashboard Cite

Hypothyroidism is among the common clinical conditions which are encountered in the medicine OPD. An autoimmune disorder called Hashimoto’s thyroiditis is a common cause for hypothyroidism followed by over response to hyperthyroidism treatment, radiation therapy, medications, congenital disease etc. Patients can present with sensitivity to cold, weight gain, constipation, menstrual abnormalities, and slow mentation with irritability, dry skin, hair loss, and fatigue. Rarely, uncontrolled hypothyroidism can present as pericardial effusion, pleural effusion and ascites. Ascites as the feature of hypothyroidism is uncommon and only less than four percent of patients with hypothyroidism /develop ascites.As it is rarely presented as ascites so its diagnosis is delayed but once it is diagnosed, treatment leads to clinical improvement.: A 20-year-old female presented to medicine OPD with non- tender abdominal distension, vomiting. She was a known case of Hashimoto's thyroiditis an autoimmune disorder; however, she was not compliant to thyroid medication. All necessary investigations were carried out to rule out the cause for ascites. With all the negative reports including imaging and supportive fluid cytology we attributed the symptoms to uncontrolled hypothyroidism as the patient was non-compliant to the thyroid medications. Also the picture of macrocytic anaemia in our patient supported the diagnosis. She was started on levothyroxine and was counselled. On a follow-up visit there was dramatic improvement of all the symptoms including ascites and her TSH was normal-2.017. Ascites as a symptom of hypothyroidism is rare and its pathophysiology is not fully understood however there are few theories and studies in the past which do explain ascites as the manifestation of hypothyroidism. Severe uncontrolled hypothyroidism though uncommon but can cause ascites. Being a reversible cause of ascites, it becomes important for clinicians to take hypothyroidism as one of the differential diagnosis for ascites. Our case supports the need of taking hypothyroidism as one of the cause, as it is easily treatable and patient can show dramatic improvement.

show abstract

Severe Ascites with Hypothyroidism and Elevated CA125 Concentration: A Case Report

Cited by 7 publications

References 17 publications

Uma Causa Incomum De Ascite

Uma Causa Incomum De Ascite

Myxedema ascites? A rare presentation of ascites in severe hypothyroidism: A case report and review

Myxoedema ascites-Rare presentation of long standing hashimotos thyroiditis

Contact Info

Product

Resources

About