Clinical Review

Hypothyroidism mimicking intra-abdominal malignancy

BMJ 2002; 325 doi: http://dx.doi.org/10.1136/bmj.325.7370.946 (Published 26 October 2002) Cite this as: BMJ 2002;325:946
  1. S T M Krishnan,, research registrar,
  2. Z Philipose,, senior house officer,
  3. G Rayman,, consultant physician in diabetes and endocrinology. (raymang@ipsh-tr.anglox.uk)
  1. Diabetes Centre, Ipswich Hospital NHS Trust, Ipswich, Suffolk IP4 5PD
  1. Correspondence to: G Rayman
  • Accepted 12 February 2002

Thyroid function should be checked in all patients with ascites and raised CA 125 concentrations

Primary hypothyroidism is a relatively common endocrine disorder. Because awareness is now high and screening is easy, the condition is detected early in most patients, when symptoms and signs are mild or often non-specific. Patients with more severe hypothyroidism may present with clinical features such as coma, cerebellar ataxia, pericardial effusion, and ascites. These features mimic those of other conditions, and as severe hypothyroidism is uncommon, the condition can be overlooked. We present a case in which the clinical presentation supported by a raised CA 125 concentration led to an incorrect presumptive diagnosis of ovarian malignancy.

Case report

A 74 year old woman presented with increasing abdominal swelling over four months, along with exertional dyspnoea, lethargy, and anorexia. She had been referred by her general practitioner for an urgent surgical outpatient appointment with a provisional diagnosis of intra-abdominal malignancy. However, before her appointment she was admitted as a medical emergency because of worsening breathlessness. She gave no history of thyroid dysfunction, neck surgery, irradiation, or heart disease and was taking no drugs.

On examination she appeared cachectic and pale. She had vitiligo but no lymphadenopathy, signs of chronic liver disease, or goitre. She spoke with a hoarse voice. Her temperature was 36.5½C, pulse 70 beats/min, and blood pressure 140/80 mm Hg. The jugular venous pressure was not raised. She had moderate …

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