Background and study aim: Disturbance of thyroid functions was observed in patients with advanced liver cirrhosis. This study aimed to assess thyroid hormone levels in cirrhotic patients and to evaluate the relationship between thyroid function disturbances and cirrhotic patients with refractory ascites. Methods: This study included 244 cirrhotic patients enrolled into 3 groups: group A included 122 cirrhotic patients with refractory ascites, group B included 62 cirrhotic patients with ascites and Group C included 60 cirrhotic patients without ascites. All patients were evaluated by complete blood count, liver functions, kidney functions, coagulation profiles, serology for viral hepatitis, serum Na, serum K, urine analysis, thyroid function tests, and abdominal ultrasonography. Results: In group A, 21.3 % of patients had high TSH levels, 14.8 % had low free T3 levels and 9.8 % had low free T4 levels. Cirrhotic patients with refractory ascites had a statically significant lower levels of free T3 (2.43 ± 0.66) and free T4 (1.16 ± 0.21) (P > 0.05), but no significant difference as regard TSH levels compared to cirrhotic patients without ascites. Child C cirrhotic patients had a statistically significantly lower levels of free T3 (2.44 ± 0.68) and free T4 (1.16 ± 0.21) compared to child A cirrhotic patients (P > 0.05). Conclusion: The percentage of elevated TSH levels and decreased free T3 and T4 levels was more in cirrhotic patients with refractory ascites. Hypothyroidism could be a risk factor for the occurrence of refractory ascites in patients with advanced liver cirrhosis.