Respiratory failure with myxedema ascites in a patient with idiopathic myxedema

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.