Abstract
Refractory ascites are sometimes observed in patients receiving maintenance hemodialysis. The common causes are known to be volume overload due to congestive heart failure, liver cirrhosis, or peritonitis. We reported a 72-year-old woman who developed refractory and massive ascites due to hypothyroidism 1 month after the initiation of hemodialysis therapy. In the present case, the diagnosis of myxedema ascites was difficult because, 1) the symptoms and signs specific for hypothyroidism were absent despite marked hormonal depletion (free T3; 0.7pg/ml, free T4; 0.28ng/dl, and TSH; 170μU/ml), 2) hypothyroidism rarely causes massive ascites, 3) nonspecific symptoms of hypothyroidism are similar to those of uremia. The ascites disappeared after replacement therapy with levothyroxine sodium for months. Myxedema ascites are rare but should be considered in the differential diagnosis of refractory ascites in the hemodialyzed patients.
