Hypothyroidism with Suspected Ovarian Malignancy: A Case Report / 대한내과학회지

ABSTRACT

We report a 44-year-old woman with massive ascites, elevated serum carbohydrate antigen 125 (CA 125) concentrations, pericardial effusion, and junctional bradycardia. Ascites caused by hypothyroidism are rare, and the pathogenesis is unclear. The ascitic fluid showed elevated total protein concentrations and a high serum-ascites albumin gradient. The massive ascites and increased serum, ascitic, and pericardial CA 125 concentrations led us to make an incorrect presumptive diagnosis of an ovarian malignancy with metastasis. However, there was no evidence of malignancy except the elevated CA 125 level. Similar to ascites, also junctional escape rhythm with marked bradycardia is a very rare feature of hypothyroidism. Following thyroid hormone replacement, the ascites and serum CA 125 gradually decreased, and the heart rhythm returned to sinus bradycardia. We report this case with a brief review of the literature.