Case report of hypothyroidism presenting with myxedema ascites

Primary hypothyroidism rarely presents with ascites. This clinical finding in a patient with history suggestive of hypothyroidism should prompt thyroid testing. Diagnostic workup should include a paracentesis and determination of the SAAG. Review of the literature revealed sixty three well documented cases of myxedema ascites. A majority of these had SAAGs of >1.1g/dL and total proteins of >2.5 g/dL. Myxedema as a cause of ascites should be considered and ruled in by exclusion. Treatment with thyroid replacement remains an effective solution with an excellent prognosis.