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Among the many symptoms of hypothyroidism are changes to the gut microbiome and digestive system. Frequently, people with hypothyroidism experience weight gain, constipation, bloating, and, in some cases, acid reflux and heartburn. There is another gastrointestinal issue that affects people with hypothyroidism, called ascites (pronounced "uh-site-ease.") Ahead, a look at the link between an underactive thyroid gland and this condition involving an accumulation of fluid in the abdomen.
To understand ascites, let’s first look at the anatomy of the abdominal cavity. Surrounding the abdominal organs (stomach, bowels, liver, and kidney) is a tissue called the peritoneum. The peritoneum has two layers that protect and insulate your organs, holding them in place and secreting a lubricating fluid -- called ascitic fluid -- to reduce friction when they rub against each other. When there's too much ascitic fluid formation building up between these two layers, it causes ascites.
Patients with ascites can experience a variety of uncomfortable symptoms due to ascites fluid accumulation, including an enlarged belly, and rapid weight gain. Other symptoms include swelling in the ankles, shortness of breath, abdominal pain, loss of appetite, indigestion, back pain, difficulty sitting, and fatigue. Ascites is typically diagnosed through imaging scans, such as an ultrasound or CT scan.
Ascites resulting from hypothyroidism is not common, affecting less than 4% of patients with autoimmune hypothyroidism or hypothyroidism. That said, there are two main theories as to how hypothyroidism can cause ascites:
- Low levels of circulating thyroid hormones cause an increase in capillary permeability, leading to the leakage of plasma proteins
- An accumulation of hyaluronic acid in the skin results in edema, a condition where the blood vessels leak fluid and result in excessive swelling
When a thyroid patient has common ascites symptoms such as unexplained weight gain, constipation, and fatigue, it is recommended to also test for ascites. Aside from an ultrasound or CT scan for a confirmed diagnosis, a fluid analysis of the ascitic fluid frequently shows elevated protein and low white blood cell counts, such as lymphocytes.
Several studies have shown that thyroid replacement therapy showed can help treat and even completely reverse ascites. The first study of a 56-year-old woman with long-standing Hashimoto's thyroiditis found that after an initial diagnosis of ascites, thyroid hormone replacement therapy improved her thyroid function and resulting in the resolution of ascites.
A second study looked at a 61-year-old man with generalized weakness, difficulty breathing, and a 23-pound weight gain over five months. The study reported that treatment with thyroid hormone replacement medication was an effective therapy to treat both conditions.
Lastly, a third study evaluated a 70-year-old man with increasing weakness, shortness of breath, weight gain, constipation, and abdominal distention. The patient showed a significant clinical improvement after only two months of monitoring and thyroid replacement therapy. This patient also required a treatment called paracentesis, where excess ascitic fluid from the peritoneum is drained to help relieve pressure in the abdomen. That treatment -- along with thyroid replacement therapy -- proved to be successful for this patient.
Hypothyroidism can be complex to diagnose, and monitoring thyroid hormone levels can be a challenge as well. That's why it's important to watch for any irregular symptoms you might be experiencing. Some symptoms might be a direct effect of hypothyroidism while others, like abdominal distention and unexplained weight gain, could be the result of an entirely different condition such as ascites.
It's also important to maintain optimal thyroid function to avoid complications and related conditions like ascites. This is where Paloma can be an essential part of your thyroid health team. Paloma's convenient Complete Thyroid home test kit makes it easy to run thyroid function tests and gauge treatment success. Guiding the process are Paloma Health's thyroid-savvy practitioners, who are committed to helping you find answers and solutions for your hypothyroidism, including optimal treatment with thyroid hormone replacement therapy to help resolve related conditions such as abdominal ascites.