A male person of 55 years with hypothyroidism, ascites and heart failure.

Primary hypothyroidism is a common clinical condition but ascites caused by hypothyroidism is rare. Concurrent exudative ascites with heart failure even rarer. So its diagnosis is often delayed and patients frequently receive unnecessary procedures such as liver biopsies and exploratory laparotomies. We report a male person of 55 years with hypothyroidism with ascites and heart failure who responded well with thyroid hormone replacement therapy with complete resolution of ascites. Analyses of ascites from patients in this condition usually shows exudative ascites with high protein (>2.5gm/dl) and SAAG <1.1gm/dl. High index of suspicion is required to reach at such diagnosis. Though it is a rare but prognosis is excellent with replacement therapy.