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Hypothyroidism and Transudative Ascites: Highlighting a Little-known Association

Received: 29 December 2023     Accepted: 6 March 2024     Published: 29 September 2024
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Abstract

Hypothyroidism is a frequent condition in medical practice and clinical forms with ascites are exceptionally rare. After a review of the literature we found that the exudative nature of the fluid is the main feature associated with hypothyroidism, however no case of hypothyroidism associated with transudative ascites has been reported. We report a case of transudative ascites associated with hypothyroidism in a post thyroidectomy setting. This 72-year-old patient underwent total thyroidectomy 3 years ago, without supplementation with synthetic thyroid hormone. He had been treated in cardiology for compensated ischaemic heart disease for 4 months. He presented with apathy, significant physical asthenia and a hoarse voice. His general condition was altered, with a rounded, puffy face and infiltrated eyelids. The feet were oedematous. Haemodynamic constants revealed arterial hypotension. Ascites aspiration yielded a sterile, pauci-cellular, citrine-yellow, transudative fluid. After ruling out renal, glomerular and hepatic causes, the ascites persisted despite optimised treatment of his heart disease, making cardiac ascites unlikely. Signs of hypometabolism and myxedema, together with a very high TSH (TSHus = 54.26 microgr/L) and disappearance of ascites after thyroid hormone supplementation, supported the hypothesis of transudative ascites associated with hypothyroidism. Ascites associated with hypothyroidism is rare and the transudative nature of the fluid is exceptional; it is generally included in myxedema. Hypothyroidism is rarely manifested by ascites but can be considered after ruling out common causes. Hormonal treatment allows complete regression of ascites within a few weeks and constitutes a therapeutic test.

Published in International Journal of Diabetes and Endocrinology (Volume 9, Issue 3)
DOI 10.11648/j.ijde.20240903.12
Page(s) 61-64
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Hypothyroidism, Transudative Ascites, Myxedema

References
[1] I. Akkari a, S. Mrabet a, Y. Hasni. Hypothyroidism: a rare cause of exudative ascites. Annales d'Endocrinologie. 2018, Volume 79, Issue 4, Page 363.
[2] Zafar Y, Suddaby SR, Shafiq M. Hypothyroidism Manifesting as a Combination of Ascites and Malnutrition Requiring Total Parenteral Nutrition: A Unique Presentation. Cureus. 11(8): e5338.
[3] Carrier P, Jacques J, Debette-Gratien M, Legros R, Sarabi M, Vidal E, et al. L’ascite non liée à la cirrhose : physiopathologie, diagnostic et étiologies. Rev Médecine Interne. 1 juin 2014; 35.
[4] WATANAKUNAKORN C, HODGES RE, EVANS TC. Myxedema: A Study of 400 Cases. Arch Intern Med. 1 août 1965; 116(2): 183-90.
[5] Vidhya Subramanian, Subhashini Yaturu. Symptomatic ascites in a patient with hypothyroidism of short duration. Am J Med Sci. 2007 Jan; 333(1): 48-52.
[6] Jeong-Seon Ji, Hiun-Suk Chae, Young-Seok Cho. Myxedema ascites: case report and literature review. J Korean Med Sci. 2006, 21(4): 761-4.
[7] Sana Riaz, Pujitha Kudaravalli, Michelle Bernshteyn Myxedema ascites complicated by ischemic colitis.
[8] F de Castro 1, M Bonacini, J M Walden. Myxedema ascites. Report of two cases and review of the literature. J Clin Gastroenterol. 1991 Aug; 13(4): 411-4.
[9] Naoki Gotyo 1, Makiyo Hiyama, Junichiro Adachi. Respiratory failure with myxedema ascites in a patient with idiopathic myxedema. Intern Med. 2010; 49(18): 1991-6.
[10] A. Laargane (Dr), S. Moussaoui (Dr), G. Belmejdoub (Pr); Isolated ascites revealing peripheral hypothyroidism: a rare clinical entity. Annals of Endocrinology. 2016 Volume 77, Issue 4, Page 387.
[11] Parving HH, Hansen JM, Nielsen SL, Rossing N, Munck O, Lassen NA. Mechanisms of edema formation in myxedema--increased protein extravasation and relatively slow lymphatic drainage. N Engl J Med. 30 août 1979; 301(9): 460-5.
[12] A. Grati, M. Boudabous, L. Chtourou, L. Mnif, A. Amouri, N. Tahri; Isolated ascites revealing hypothyroidism: about 3 cases; La Revue de Médecine Interne 2016 Volume 37, Page A199.
[13] Yousaf Zafar, Stephanie R Suddaby, Mohammed Shafiq. Hypothyroidism Manifesting as a Combination of Ascites and Malnutrition Requiring Total Parenteral Nutrition: A Unique Presentation. Cureus. 2019 Aug 7; 11(8)
[14] Cyriac Abby Philips, Uma Sinha, Partha Chattopadhyay. Isolated ascites in hypothyroidism: medical and ethical issues. J Indian Med Assoc. 2010 Aug; 108(8): 523-4. PMID: 21404750.
[15] Hideo Kanehara, Yukihiro Bando, Manabu Tomita. Myxedema ascites with an extremely elevated CA125 Level: a case report. Endocr J. 2007 Aug; 54(4): 601-4.
[16] Rohit Dhingra, Puja Rai, Jakob Sieker. Myxedema Ascites: An Unusual Presentation of Uncontrolled Hypothyroidism Cureus. 2018 May 14; 10(5).
[17] Hans-Henrik P, Hansen JM, Nielsen SL, et al. Mechanisms of edema formation in myxedema - increased protein extravasation and relatively slow lymphatic drainage. New England Journal of Medicine. 1979; 301: 460-5.
[18] Baghal M, Amrutiya V, Patel B, et al. Pericardial Tamponade and Elevated Serum CA-125 Level in Inadequately Treated Hypothyroidism. Case Rep Cardiol 2021; Nov10: 2666601.
Cite This Article
  • APA Style

    Barry, I. S., Diack, N. D., Ndiaye, N., Leye, A. (2024). Hypothyroidism and Transudative Ascites: Highlighting a Little-known Association. International Journal of Diabetes and Endocrinology, 9(3), 61-64. https://doi.org/10.11648/j.ijde.20240903.12

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    ACS Style

    Barry, I. S.; Diack, N. D.; Ndiaye, N.; Leye, A. Hypothyroidism and Transudative Ascites: Highlighting a Little-known Association. Int. J. Diabetes Endocrinol. 2024, 9(3), 61-64. doi: 10.11648/j.ijde.20240903.12

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    AMA Style

    Barry IS, Diack ND, Ndiaye N, Leye A. Hypothyroidism and Transudative Ascites: Highlighting a Little-known Association. Int J Diabetes Endocrinol. 2024;9(3):61-64. doi: 10.11648/j.ijde.20240903.12

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  • @article{10.11648/j.ijde.20240903.12,
      author = {Ibrahima Sory Barry and Ngone Diaba Diack and Nafy Ndiaye and Abdoulaye Leye},
      title = {Hypothyroidism and Transudative Ascites: Highlighting a Little-known Association
    },
      journal = {International Journal of Diabetes and Endocrinology},
      volume = {9},
      number = {3},
      pages = {61-64},
      doi = {10.11648/j.ijde.20240903.12},
      url = {https://doi.org/10.11648/j.ijde.20240903.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijde.20240903.12},
      abstract = {Hypothyroidism is a frequent condition in medical practice and clinical forms with ascites are exceptionally rare. After a review of the literature we found that the exudative nature of the fluid is the main feature associated with hypothyroidism, however no case of hypothyroidism associated with transudative ascites has been reported. We report a case of transudative ascites associated with hypothyroidism in a post thyroidectomy setting. This 72-year-old patient underwent total thyroidectomy 3 years ago, without supplementation with synthetic thyroid hormone. He had been treated in cardiology for compensated ischaemic heart disease for 4 months. He presented with apathy, significant physical asthenia and a hoarse voice. His general condition was altered, with a rounded, puffy face and infiltrated eyelids. The feet were oedematous. Haemodynamic constants revealed arterial hypotension. Ascites aspiration yielded a sterile, pauci-cellular, citrine-yellow, transudative fluid. After ruling out renal, glomerular and hepatic causes, the ascites persisted despite optimised treatment of his heart disease, making cardiac ascites unlikely. Signs of hypometabolism and myxedema, together with a very high TSH (TSHus = 54.26 microgr/L) and disappearance of ascites after thyroid hormone supplementation, supported the hypothesis of transudative ascites associated with hypothyroidism. Ascites associated with hypothyroidism is rare and the transudative nature of the fluid is exceptional; it is generally included in myxedema. Hypothyroidism is rarely manifested by ascites but can be considered after ruling out common causes. Hormonal treatment allows complete regression of ascites within a few weeks and constitutes a therapeutic test.
    },
     year = {2024}
    }
    

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    T1  - Hypothyroidism and Transudative Ascites: Highlighting a Little-known Association
    
    AU  - Ibrahima Sory Barry
    AU  - Ngone Diaba Diack
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    DO  - 10.11648/j.ijde.20240903.12
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    PB  - Science Publishing Group
    SN  - 2640-1371
    UR  - https://doi.org/10.11648/j.ijde.20240903.12
    AB  - Hypothyroidism is a frequent condition in medical practice and clinical forms with ascites are exceptionally rare. After a review of the literature we found that the exudative nature of the fluid is the main feature associated with hypothyroidism, however no case of hypothyroidism associated with transudative ascites has been reported. We report a case of transudative ascites associated with hypothyroidism in a post thyroidectomy setting. This 72-year-old patient underwent total thyroidectomy 3 years ago, without supplementation with synthetic thyroid hormone. He had been treated in cardiology for compensated ischaemic heart disease for 4 months. He presented with apathy, significant physical asthenia and a hoarse voice. His general condition was altered, with a rounded, puffy face and infiltrated eyelids. The feet were oedematous. Haemodynamic constants revealed arterial hypotension. Ascites aspiration yielded a sterile, pauci-cellular, citrine-yellow, transudative fluid. After ruling out renal, glomerular and hepatic causes, the ascites persisted despite optimised treatment of his heart disease, making cardiac ascites unlikely. Signs of hypometabolism and myxedema, together with a very high TSH (TSHus = 54.26 microgr/L) and disappearance of ascites after thyroid hormone supplementation, supported the hypothesis of transudative ascites associated with hypothyroidism. Ascites associated with hypothyroidism is rare and the transudative nature of the fluid is exceptional; it is generally included in myxedema. Hypothyroidism is rarely manifested by ascites but can be considered after ruling out common causes. Hormonal treatment allows complete regression of ascites within a few weeks and constitutes a therapeutic test.
    
    VL  - 9
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    ER  - 

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Author Information
  • Department of Internal Medicine - Endocrinology - Metabolism - Nutrition, Centre Hospitalier National de Pikine, Dakar, Senegal; Department of Internal Medicine - Endocrinology - Metabolism - Nutrition, Donka National Hospital, Conakry, Rep Guinea

  • Department of Internal Medicine - Endocrinology - Metabolism - Nutrition, Centre Hospitalier National de Pikine, Dakar, Senegal

  • Department of Internal Medicine - Endocrinology - Metabolism - Nutrition, Centre Hospitalier National de Pikine, Dakar, Senegal

  • Department of Internal Medicine - Endocrinology - Metabolism - Nutrition, Centre Hospitalier National de Pikine, Dakar, Senegal

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