Abstract: FR-PO005

Hypothyroidism with Rhabdomyolysis Causing AKI

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Villegas, Antonio Manuel, CEDIMAT., Santo Domingo, Dominican Republic
  • Goris felix, Macgivenny A, CEDIMAT, Santo Domingo, Dominican Republic
  • Flores, Alberto, CEDIMAT, Santo Domingo, Dominican Republic
  • Mejia, Freddy, CEDIMAT, Santo Domingo, Dominican Republic
  • Alvarez, Guillermo, None, REPÚBLICA DOMINICANA, Dominican Republic
Background

Muscle complaints is frequent in adult onset hypothyroidism, accompanied by mild elevation of serum creatine kinase, but few cases have reported extremely high elevations of serum creatine kinase and rhabdomyolysis and acute renal failure.

We report a case of acute kidney injury (AKI) associated with rhabdomyolysis secondary to severe hypothyroidism in a 57 year old female. The patient had general weakness, without muscle tenderness, elevated muscle enzymes and thyroid stimulating hormone (TSH), which normalized with thyroid replacement therapy.

Methods

A 57 year old female admitted to the general ward with complaints of general weakness, fatigue and body swelling, prominently on both legs. She denied any neither physical activity nor trauma, all beginning 1 week prior admission.

She was pale, afebrile, had leg pitting edema, no goiter with no muscle weakness or tenderness.

Investigation revealed: hemoglobin 10.2 g/dL, white blood cells 3.9 x 109L, blood urea nitrogen 53 mg/dL, creatinin 7.24 mg/dL, aspartate aminotransferase 257 IU/L. Serum muscle enzymes were elevated; creatinin phosphokinase (CPK) >1600 U/L (upper normal limit (UNL) of 135), lactate dehydrogenase 1430 U/L (UNL of 618), and a negative antinuclear antibody. Urine analysis showed mild blood with dipstick with no erythrocytes, and a 24 hour urine collection with 0.36 g/day of protein. She reported fluctuation in mood, and weight gain in the last 6 months, TSH >100 μUI/mL, free T4 0.08 ng/dL, free T3 0.26 pg/mL and a extremely elevated anti-thyroid peroxidase (236.4 IU/mL). A thyroid scintigraphy revealed a low Tc-99m uptake.

Hydration and replacement therapy with thyroxine was started at a dose of 50 μg/day for 1 week, increased to 100 μg/day for 3 more weeks, TSH in 10.7 μUI/mL in 2 weeks, with normalization at week 8, creatinin 4.1 mg/dL and CPK 610 U/L after 2 weeks of treatment, also patient reporting the disappearing of the legs edema and the weakness after 1 week of treatment. At 3 month follow up all clinical and laboratory findings were normalized, with a creatinin 0.8 mg/dL.

Conclusion

Hypothyroidism associated rhabdomyolysis is quite rare, depending on its severity, may be complicated with acute renal failure, hypothyroidism should be suspected in patients presenting with AKI in the absence of common causes of AKI, and in patients with vague muscular symptoms.