난소암으로 오인된 갑상선 기능 저하증

Hypothyroidism with Suspected Ovarian Malignancy: A Case Report

  • 김유정 (부산가톨릭의료원 메리놀병원 순환기내과) ;
  • 김성만 (부산가톨릭의료원 메리놀병원 순환기내과) ;
  • 천민구 (부산가톨릭의료원 메리놀병원 순환기내과) ;
  • 지준형 (부산가톨릭의료원 메리놀병원 순환기내과) ;
  • 김동준 (부산가톨릭의료원 메리놀병원 순환기내과) ;
  • 송여정 (부산가톨릭의료원 메리놀병원 순환기내과) ;
  • 김태익 (부산가톨릭의료원 메리놀병원 순환기내과)
  • Kim, You-Jeong (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Kim, Seong-Man (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Chon, Min-Gu (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Jhi, Joon-Hyung (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Kim, Dong-Jun (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Song, Yeo-Jeong (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Kim, Tae-Ik (Division of Cardiology, Department of Internal Medicine, Maryknoll Medical Center)
  • 발행 : 2011.11.01

초록

We report a 44-year-old woman with massive ascites, elevated serum carbohydrate antigen 125 (CA 125) concentrations, pericardial effusion, and junctional bradycardia. Ascites caused by hypothyroidism are rare, and the pathogenesis is unclear. The ascitic fluid showed elevated total protein concentrations and a high serum-ascites albumin gradient. The massive ascites and increased serum, ascitic, and pericardial CA 125 concentrations led us to make an incorrect presumptive diagnosis of an ovarian malignancy with metastasis. However, there was no evidence of malignancy except the elevated CA 125 level. Similar to ascites, also junctional escape rhythm with marked bradycardia is a very rare feature of hypothyroidism. Following thyroid hormone replacement, the ascites and serum CA 125 gradually decreased, and the heart rhythm returned to sinus bradycardia. We report this case with a brief review of the literature.

키워드

참고문헌

  1. Mauer K, Manzione NC. Usefulness of serum-ascites albumin difference in separating transudative from exudative ascites: another look. Dig Dis Sci 1988;33:1208-1212. https://doi.org/10.1007/BF01536667
  2. Watanakunakorn C, Hodges RE, Evans TC. Myxedema: astudy of 400 cases. Arch Intern Med 1965;116:183-190. https://doi.org/10.1001/archinte.1965.03870020023008
  3. Runyon BA, Montano AA, Akriviadis EA, Antillon MR, Irving MA, McHutchison JG. The serum-ascites albumin gradient is superior to the exudates-transudate concept in the differential diagnosis of ascites. Ann Intern Med 1992;11:215-220.
  4. De Castro F, Bonacini M, Walden JM, Schubert TT. Myxedema ascites: report of two cases and review of the literature. J Clin Gastroenterol 1991;13:411-414. https://doi.org/10.1097/00004836-199108000-00010
  5. Hashimoto T, Matsubara F. Changes in the tumor marker concentration in female patients with hyper-, eu-, and hypothyroidism. Endocrinol Jpn 1989;36:873-879. https://doi.org/10.1507/endocrj1954.36.873
  6. Basaran A, Tuncer ZS. SLE and CA-125. Gynecol Oncol 2006; 100:444-445.
  7. Kouris NT, Zacharos ID, Kontogianni DD, et al. The significance of CA125 levels in patients with chronic congestive heart failure: correlation with clinical and echocardiographic parameters. Eur J Heart Fail 2005;7:199-203. https://doi.org/10.1016/j.ejheart.2004.07.015
  8. MacGowan GA, Mann DL, Kormos RL, Feldman AM, Murali S. Circulating interleukin-6 in severe heart failure. Am J Cardiol 1997;79:1128-1131. https://doi.org/10.1016/S0002-9149(96)00063-X
  9. Kanehara H, Bando Y, Tomita M, Kontani M, Takegoshi Y, Tanaka N. Myxedema ascites with an extremely elevated CA125 level: a case report. Endocr J 2007;54:601-604. https://doi.org/10.1507/endocrj.K06-185
  10. Seo T, Ikeda Y, Onaka H, et al. Usefulness of serum CA 125 measurement for monitoring pericardial effusion. Jpn Circ J 1993;57:489-494. https://doi.org/10.1253/jcj.57.489
  11. Depczynski B, Ward R, Eisman J. The association between myxedematous ascites and extreme elevation of serum tumor markers. J Clin Endocrinol Metab 1996;81:4175.
  12. Yoon SH, Shin DK, Kim MC, et al. Five cases of sick-sinus syndrome & implantation of pacemaker. Korean Circ J 1983; 13:435-442.
  13. Libby P, Bonow RO, Mann DL, Zipes DP. Braunwald's Heart Disease: a Textbook of Cardiovascular Medicine. 8th ed. Philadelphia: WB Saunders company, 2008:2033-2048.
  14. Park JR, Paik CM, Kim JK, Kim IS, Suh CY. A case of myxedema with pericardial effusion. Korean Circ J 1971;1:79-85.