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From Mary Shomon Your Thyroid Guide

Abdominal Swelling and Hypothyroidism: Hypothyroidism May Initially be Mistaken as Abdominal Cancer

from Mary J. Shomon

October, 2002 -- According to research reported on in the British Medical Journal, thyroid function should be checked in all patients with a condition called ascites (pronounced ah-sih-tez) -- an abnormal accumulation of fluid in the abdomen.

Ascites are considered a symptom of severe (and often undetected) hypothyroidism. It's considered to be a fairly known but not common feature of hypothyroidism, occurring in as many as 4% of patients.

Symptoms of ascites are:

  • Rapid weight gain
  • Abdominal discomfort and distention
  • Shortness of breath
  • Swollen ankles
The British Medical Journal reported on a case in which a woman had ascites and an elevated CA 125 concentration. The 74-year-old woman had increasingly worsening abdominal swelling along with shortness of breath and fatigue. Her doctor had preliminarily diagnosed some sort of abdominal cancer.

Other symptoms included:
  • a hoarse voice
  • low-grade fever
  • slighly elevated blood pressure
  • some swelling in the feet
  • ascites
  • elevated tumour marker / CA 125 concentration
  • dry skin
Her oncologist suspected ovarian cancer, or a metastatic stomach cancer. CAT scans, laparoscopy and various other tests, however, showed no evidence of cancer.

Finally, testing was done for thyroid function, and her TSH level was 73 (normal range 0.2-5.7) and free T4 was 5 (normal range 9-19 pmol/l). She had elevated thyroid peroxidase antibody levels.

As her thyroxine level was raised from 25 to 100 micrograms a day, her CA 125 levels returned to normal, and she had no ascites.

The researchers concluded that CA 125 levels in patients with hypothyroidism and ascites can be as high as those seen in patients with cancer, suggesting that any patient with ascites and a raised CA 125 concentration should have thyroid function measured as part of their initial evaluation.

Source: BMJ 2002;325:946-947

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