Endocrine Abstracts

Introduction: Hypothyroidism-related anasarca is due to the capillary permeability disorders associated with hypothyroidism. It is a rare mode of revelation especially when associated with ascites, which is an exceptional localization. We report the case of a deep hypothyroidism revealed by an ascites of great abundance.

Observation: Our patient is 73 years old with a history of 2 daughters followed for Hashimoto’s thyroiditis. He consults for abdominal distension associated with hoarseness, hypoacusis and constipation evolving for 3 months\. Clinical examination revealed cutaneous-mucosal infiltration, dry scaly skin and abundant ascites with positive flot sign without collateral venous circulation. The diagnosis of Hashimoto’s thyroiditis was retained in view of an elevated TSHus at 150 Uui/ml; a low LT4 at 2.48 pmol/l; very positive anti thyroperoxidase antibodies > 1000 UI/ml and an appearance of thyroiditis on cervical ultrasound. The ascites fluid study showed a sterile exudative fluid without malignant cells with a negative GeneXpert tuberculosis. The transthoracic echocardiography showed a pericardial effusion slide and the thoraco-abdomino-pelvic CT scan did not reveal any tumor focus apart from a large ascites and a small bilateral pleurisy. Hormone replacement therapy was started progressively at a dose of 75 µg/dl of L-thyroxine allowing the progressive disappearance of ascites and signs of hypo metabolism.

Conclusion: Exudative ascites remains a rare location of myxedematous hypothyroidism. Our case underlines the importance of F-T4 and TSH assay in the etiological assessment of ascites of undetermined cause and particularly in elderly subjects. This allows to avoid useless explorations which can, in rare cases, lead to the death of the patient in a myxedematous coma.