Myxedema Ascites with Elevated Serum CA 125 Concentration

Duarte, Delfim; Chang, Claudia Veiga; Minicucci, Marcos F.; Zornoff, Leonardo A. M.; Inoue, R; Matsui, Mirna; Okoshi, Marina Politi; Azevedo, Paula Schmidt; Matsubara, Luiz Shiguero; Paiva, Sérgio Alberto Rupp de

doi:10.1097/00000441-200602000-00020

Cited by 10 publications

(7 citation statements)

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“…Typical features of myxedema ascites include high protein concentration (>25 g/L), a high serum to ascites albumin gradient of >11 g/l, the presence of glycosaminoglycans, a long duration of hypothyroidism and rapid resolution of the ascites following thyroxine replacement [7]. It is rare for a case of myxedema ascites to be associated with an elevated CA 125 concentration [8,9]. The mechanisms of CA125 elevation by hypothyroidism have not been clarified; however, there are some hypotheses as follows.…”

Section: Discussionmentioning

confidence: 99%

Myxedema Ascites with an Extremely Elevated CA125 Level: A Case Report

et al. 2007

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Abstract. Carbohydrate antigen 125 (CA125) is a tumor-marker frequently associated with ovarian malignancies; however, benign gynecologic conditions (e.g. ovarian cysts) commonly cause a smaller increase in CA125 levels. This report describes an elderly Japanese woman with high CA125 levels and massive ascites caused by hypothyroidism. A 67-year-old woman presented herself with a weight gain of about 12 kg and abdominal distension. Her serum CA125 level was markedly elevated (822 U/ml) and abdominal CT revealed a right ovarian cyst and massive ascites. Hormonal laboratory data showed severe primary hypothyroidism with a serum TSH of 594 IU/L and a free thyroxin level of 0.05 ng/dl. Ascitic fluid was found to be exudate with a high protein content of 42 g/L. Cytological analysis and FDG-PET showed no evidence of malignancy. The ascites completely disappeared and serum CA125 normalized after adequate hormonal replacement therapy. These data suggest that hypothyroidism should be considered in patients with ascites and elevated serum CA125. (CA125) is an antigen related to ovarian cancer that was discovered by Bast et al. in 1981 [4]. Kabawat et al. showed that this antigen is present in tissue related to the coelomic epithelium [5]. Here we report the case of a patient with abdominal distension and an ovarian cyst whose ascites completely resolved and whose CA125 level normalized after treatment with levothyroxine sodium. A Case RepotClinical findings and laboratory studies A 67 year old woman had noticed weight gain of about 12 kg and abdominal swelling for three months. She consulted her family physician and was treated with diuretics and ARB, but her abdominal distension persisted. She was found to have an ovarian cyst and markedly elevated CA125, and was referred to our hospital for further evaluation. She denied any history of thyroid dysfunction, neck surgery or heart disease.The patient was cachectic. Physical examination revealed a height of 155 cm, a weight of 58.3 kg, and a temperature of 36.2°C. Blood pressure was 102/ 62 mmHg, and pulse rate 58 beats/min with regular rhythm. Her voice was slightly hoarse but her thyroid and lymph nodes were not palpable. Lungs were clear

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Section: Discussionmentioning

confidence: 99%

Myxedema Ascites with an Extremely Elevated CA125 Level: A Case Report

et al. 2007

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“…Myxedema ascites appear in fewer than 4% of patients with hypothyroidism (3), and are promptly reduced with thyroid hormone replacement according to previous reports (4)(5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 80%

“…Hypothyroidism is assumed to cause an increase in capillary permeability, followed by the escape of protein-rich fluid into the extravascular component and produce ascites with the above-mentioned properties (11). The serum CA 125 level, a well-established tumor marker of epithelial ovarian carcinoma, is also elevated in the pathology of ascites due to nonmalignant diseases such as liver cirrhosis, peritoneal tuberculosis, and myxedema ascites (7)(8)(9). It is known that CA125 is produced not only by malignant cells, but also by the normal epithelial cells of the peritoneum (12), and it may increase as a nonspecific response to the presence of fluid in the peritoneal cavity (7).…”

Section: F I G U R E 3 Ch E S T X R a Y O N T H E 1 0 T H H O S P Imentioning

confidence: 99%

Respiratory Failure with Myxedema Ascites in a Patient with Idiopathic Myxedema

et al. 2010

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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.

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“…High circulating levels of TSH acting directly on FSH receptors may be the actual mediator of precocity. 6 The multicystic ovaries may result from elevated levels of circulating gonadotropins acting on it. It is also possible that increased sensitivity of the ovaries to the circulating gonadotropins could result from the hypothyroid state directly or via increased prolactin.…”

Section: Discussionmentioning

confidence: 99%