Chylous ascites as a manifestation of thyrotoxic cardiomyopathy in a patient with untreated Graves' disease.
BACKGROUND
Thyrotoxicosis is an uncommon cause of heart failure, and patients with heart failure rarely present with chylous ascites. In this report, we describe a patient with uncontrolled Graves' disease with thyrotoxicosis, heart failure, and chylous ascites.


CONCLUSIONS
A 39-year-old woman with no previous cardiac disease presented with dyspnea, orthopnea, palpitations, exophthalmos, goiter, distended abdomen, and pedal edema. The thyroid function tests demonstrated hyperthyroid Graves' disease (serum-free triiodothyronine level, 7.12 pg/mL [reference range, 2.0-4.0]; free thyroxine level, 4.33 ng/dL [reference range, 0.54-1.40]; thyroid-stimulating hormone level, <0.015 microU/mL [reference range, 0.34-5.60]; and thyrotropin receptor antibodies, 84.5% [reference value, <15%]). The chest radiograph showed moderate cardiomegaly and bilateral pleural effusions, electrocardiogram revealed atrial fibrillation, and the abdominal sonography found ascites. Chylous ascites was diagnosed by paracentesis and analysis of the ascitic fluid (triglyceride level, 347 mg/dL). Laboratory and imaging studies demonstrated no apparent hepatic dysfunction, abnormal tumor, lymphadenopathy, or lymphatic drainage deficit. With aggressive treatment of the heart failure and hyperthyroid state, her dyspnea, pleural effusion, chylous ascites, and edema resolved completely within a few days.


CONCLUSIONS
Chylous ascites may develop as a result of heart failure secondary to thyrotoxic cardiomyopathy and resolve promptly if treated appropriately.
Hsieh
Min-Huang
MH
Division of Endocrinology and Metabolism, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Chen
Ching-Chu
CC
Wang
Tzu-Yuan
TY
Chang
Chwen-Tzuei
CT
D009202:Cardiomyopathies / Q000150:complications*; D002915:Chylous Ascites / Q000188:drug therapy / Q000209:etiology*; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006111:Graves Disease / Q000150:complications*; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D011433:Propranolol / Q000627:therapeutic use; D013971:Thyrotoxicosis / Q000150:complications*
D004232:Diuretics; D011433:Propranolol