Myxedema ascites

Abstract

A 74-year-old man presented with mental obtundation and massive ascites without evidence of significant impairment of liver function. Thyroid function studies suggested hypothyroidism. Aspirated ascitic fluid had the characteristics of an exudate. Thyroid replacement therapy resulted in rapid clinical improvement with resolution of the ascites. Prompt recognition of myxedema ascites may prevent the inappropriate use of diuretic agents, therapeutic paracentesis, and sometimes unnecessary laparotomy.

Recurrent ascites with severe hypoproteinemia in 4-year-old child: A diagnostic dilemma - An atypical presentation of hypothyroidism

“…Review of literature revealed 52 documented cases of myxedema ascites in adults. [4589] A very consistent finding was high total protein level (>2.5 g/dl) in almost all cases with mean SAAG of 1.5 g/dl with a range of 0.8-2.3 g/dl. [1] WBC counts were rather low, usually with a lymphocytic predominance with a mean of 60 cells/μl and 81% lymphocytes.…”

“…Prompt recognition of hypothyroid ascites prevents the inappropriate use of diuretics and unnecessary procedures, including repeated paracenteses and liver biopsies. [8]…”

Myxedema Ascites: Case Report and Literature Review

“…A review of the literature turned up 51 well-documented cases of myxedema ascites (Table 1) (2,3,7,8,10-20). A very consistent finding was the high total protein level (>2.5 g/dL) (7).…”

“…There was usually a significant delay in the diagnosis, with a mean of eight months. Prompt recognition of myxedema ascites prevents the inappropriate use of diuretics and unnecessary procedures, including repeated paracenteses, liver biopsies and exploratory laparotomies (10). A constant feature was the good response to thyroid hormone replacement therapy, which led to elimination of the ascites in every instance.…”