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This 57-year-old bartender had longstanding ascites attributed to presumed hepatic cirrhosis.
Immediate clues to hypothyroidism in this man were his expressionless face, periorbital puffiness, pallor, peripheral edema, and,of course, his massive ascites. Indeed, because it is curable, myxedema should be considered in every patient with conspicuous ascites, except perhaps thosewith widespread or terminal malignancy. The patient shown received thyroid replacement therapy, and all of his physical abnormalities vanished.
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