Isolated ascites in hypothyroidism: medical and ethical issues

Hypothyroidism presenting as ascites is one of the rarest clinical scenarios encountered in medical practice. A case of a 65-year-old woman, presenting with progressive onset ascites, secondary to underlying hypothyroidism, which responded to thyroid hormone replacement therapy is reported. A feature of hypothyroidism Induced ascites is the high protein content of the ascitic fluid (> 2.5 g/dl), a high serum albumin ascites gradient (SAAG) and the consistent drastic response of ascites to thyroid hormone replacement. Hypothyroid ascites is thus a very rare manifestation of the primary disease, but should be borne in mind when other causes of ascites are ruled out and the ascitic fluid shows typical features.