Kidney Week

Abstract: SA-PO0373

The Kidneys Under the Influence of Thyroid Disease: A Case Series

Session Information

• AKI: Case Reports - Drug/Toxin Injury, Crystals, Obstruction, and Unusual Presentations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Khan, Salwa, West Virginia University, Morgantown, West Virginia, United States

Salwa Khan, MBBS

• Smith, Coy, West Virginia University, Morgantown, West Virginia, United States

Coy Smith, MD

• Murari, Ujjwala, West Virginia University, Morgantown, West Virginia, United States

Ujjwala Murari, MD

• Shawwa, Khaled, West Virginia University, Morgantown, West Virginia, United States

Khaled Shawwa, MD, MS, FASN

• Diab, Anas, West Virginia University, Morgantown, West Virginia, United States

Anas Diab, MD

Introduction

The association between thyroid disease and kidney disease is well established. Thyroid hormones play a critical role in cellular function across all organ systems, including the kidneys. Given the broad differential diagnosis for acute kidney injury (AKI), a thorough and systematic evaluation is essential to identify the underlying etiology. We present 3 cases with AKI caused by hypothyroidism.

Case Description

Case 1: A 46-year-old female with a history of hypertension and CKD 3A with baseline creatinine (Cr) of 1.2 mg/dl presented to the nephrology clinic with a sudden increase in Cr to 2.4 repeat showed persistent elevation further work up revealed TSH 260 and undetectable free T4. Thyroid function was normal a year ago.
A month from starting levothyroxine 125 mcg, renal function showed improvement in Cr to 1.4 , at 3 months TSH was 1.5 and Cr was at baseline 1.2 mg/dl.
Case 2: An 83-year-old female with known CKD 3A, was started on Amiodarone for ventricular arrhythmia and a month later she presented with fatigue and shortness of breath. Testing showed TSH of 17 and undetectable free T4 with Cr 1.56 mg/dl.
Initially thought to have nephrotic syndrome due to significant peripheral edema, She was then diagnosed with amiodarone induced hypothyroidism and started on levothyroxine 125mcg. Six weeks later, TSH was 4 and Cr returned to baseline of 1.1 mg/dl.
Case 3: A 62 year-old female with known uncontrolled hypothyroidism, presents with severe constipation and found to have elevated TSH of 288 and AKI with Cr 1.5 from baseline of 0.8-1 mg/dl. Patient had stopped taking her medications for a few weeks prior to presentation. After resuming home levothyroxine 112 mcg within 3 days Cr returned to baseline of 0.8 mg/dl.

Discussion

In the evaluation of AKI, broad differential is essential, specially when common etiologies do not fully explain the clinical picture.
Hypothyroidism, though often overlooked, is a reversible cause of AKI with an estimated prevalence of 1.9%. Mechanisms include rhabdomyolysis, low cardiac output, and cardio-renal syndrome from acute heart failure. Risk factors include CKD, female sex, advanced age, and amiodarone use. Maintaining a low threshold for evaluating thyroid dysfunction in the CKD population - particularly in the setting of an unexplained or disproportionate rise in serum creatinine - is critical. Failure to recognize this association may delay appropriate treatment and prolong renal dysfunction.