腹水是腹腔中的液体积聚,通常归因于各种病因,包括门脉高压和腹膜疾病。甲状腺功能亢进很少与腹水相关,典型的乳糜性且伴有高中心静脉压。我们介绍了一个独特的病例,即一名57岁的女性未经治疗的甲状腺功能亢进症患者,其表现为非乳糜性腹水,而没有高静脉压的证据。最初表现为左小腿疼痛,患者出现腿部水肿,腹胀,和腹泻。一系列诊断测试排除了腹水的常见病因,比如肝硬化,肾功能损害,心力衰竭,感染,和恶性肿瘤。腹水的特点是甘油三酯水平低,而没有发现高静脉压的证据。值得注意的是,患者显示快速周转蛋白水平下降,提示甲状腺功能亢进导致的分解代谢过度和蛋白质合成不足。开始抗甲状腺治疗后,患者的症状明显改善。总之,本报告重点介绍了一种罕见的甲状腺功能亢进症表现,该表现导致无静脉压的非乳糜性腹水。这强调了在不明原因的腹水的鉴别诊断中需要包括甲状腺功能亢进,特别是在没有经典甲状腺功能亢进症状的情况下。
Ascites is the accumulation of fluid in the abdominal cavity and is commonly attributed to various etiologies, including portal hypertension and peritoneal diseases. Hyperthyroidism is rarely associated with ascites, which is typically chylous and accompanied by high central venous pressure. We present a unique case of a 57-year-old woman with untreated hyperthyroidism who manifested non-chylous ascites without evidence of high venous pressure. Initially presenting with left lower leg pain, the patient presented with leg edema, abdominal distention, and diarrhea. A range of diagnostic tests ruled out common etiologies of ascites, such as liver cirrhosis, renal impairment, heart failure, infection, and malignancy. Ascites was characterized by low triglyceride levels, while no evidence of high venous pressure was found. Notably, the patient showed decreased levels of rapid turnover proteins, suggesting hypercatabolism and insufficient protein synthesis due to hyperthyroidism. Upon the initiation of antithyroid therapy, the patient\'s symptoms markedly improved. In conclusion, this report highlights a rare manifestation of hyperthyroidism that resulted in non-chylous ascites without high venous pressure. This underscores the need to include hyperthyroidism in the differential diagnosis of unexplained ascites, particularly in cases in which classical hyperthyroid symptoms are absent.