Endocrine Abstracts

Introduction: Clinical presentation of hypothyroidism is frequently insidious. Of the many non specific clinical signs of hypothyroidism, ascites is one of the less common manifestations reported and the diagnosis is often made late with this condition. Herein, we present the cases of isolated ascites revealing hypothyroidism in order to drow attention to hypothyroidism as an etiology of an unexplained isolated ascites.

Observation: A 61-year-old diabetic women presented with abdominal distention, constipation and ascites of three months duration. On physical examination, blood pressure was 130/70 mmHg and the pulse rate was 80/min. The abdomen was distended with marked ascitic fluid. Neither the liver nor spleen were palpable. The thyroid gland was also not palpable. There were no signs of congestive heart failure and the electrocardiogram was normal. The initial exploration of ascites could not suggest any etiology: hemogram, bilirubin level, Liver function, protein electrophoresis and creatinine level were normal. There was no proteinuria. Viral serologies B and C and immunoassay were negative. The intradermal reaction to tuberculin was negative. The ascites puncture revealed a transparent fluid, its cell count was 141/mm³ with 95% lymphocytes, its protein concentration was 36.5 g/l and cultures were negative. Both diuretics (spironolactone) and a sodium restricted diet were prescribed with no improvement. Few month later, the patient developed profound weakness, bradycardia (pulse rate 60/min) and hypoacousia suggesting the diagnosis of hypothyroidism. Thyroid function tests showed a low serum FT4 (1.4 pg/ml reference range :6.6–14 pg/ml) and an elevated serum TSH (75 µU/ml: reference ranges 0.2–3.5 µU/ml). The patient was treated initially with levothyroxine (L-T4) 25 µg/day and gradually increased to 200 µg/day. The ascites rapidly disappeared about 1 month and a half after the start of replacement therapy.

Conclusion: Ascites can be an early clinical magnifestation of hypothyroidism. It is rapidly reversible after hormone replacement therapy, therefore evaluation of thyroid functions should be performed in all patients with unexplained ascites.