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Myxedema ascites with an extremely elevated CA125 Level: a case report.
Hideo Kanehara1, Yukihiro Bando, Manabu Tomita
1Department of Internal Medicine, Fukui Saiseikai Hospital, Fukui 918-8503, Japan.
Endocrine Journal
|July 21, 2007
Summary
Hypothyroidism can cause elevated Carbohydrate antigen 125 (CA125) levels and ascites, mimicking ovarian cancer. Prompt diagnosis and treatment of hypothyroidism resolved these symptoms in a patient.
Area of Science:
- Endocrinology
- Gynecology
- Oncology
Background:
- Carbohydrate antigen 125 (CA125) is a biomarker often associated with ovarian cancer.
- Benign gynecological conditions can also cause mild elevations in CA125.
- Massive ascites and elevated CA125 levels can present diagnostic challenges.
Observation:
- An elderly Japanese woman presented with significant weight gain, abdominal distension, and markedly elevated serum CA125 (822 U/ml).
- Abdominal CT revealed a right ovarian cyst and massive ascites.
- Hormonal tests indicated severe primary hypothyroidism (TSH: 594 IU/L, free thyroxine: 0.05 ng/dl).
Findings:
- Ascitic fluid analysis showed exudate with high protein content (42 g/L).
- Cytological analysis and FDG-PET scans excluded malignancy.
- The patient's ascites resolved, and serum CA125 normalized following thyroid hormone replacement therapy.
Implications:
- Hypothyroidism should be considered in the differential diagnosis of patients presenting with ascites and elevated CA125 levels.
- This case highlights the importance of comprehensive hormonal evaluation in unexplained ascites.
- Timely diagnosis and treatment of hypothyroidism can prevent unnecessary invasive procedures and manage symptoms effectively.
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