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      Rhabdomyolysis case based on hypothyroidism

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          Summary

          Hypothyroidism is a wide clinical spectrum disorder and only a few cases in literature show this. Rhabdomyolysis and acute renal impairment can be seen concurrently in a hypothyroid state. We report a case of severe hypothyroidism with poor drug compliance leading to rhabdomyolysis and acute kidney injury.

          Learning points:

          • Hypothyroidism is a rare cause of acute kidney injury.

          • In this case report, we studied a rare occurrence of acute renal impairment due to hypothyroidism with poor drug compliance, which induced rhabdomyolysis.

          • Our report emphasized that thyroid status should be evaluated in patients with unexplained acute renal impairment or presenting with the symptoms of muscle involvement.

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          Clinical and biochemical features of muscle dysfunction in subclinical hypothyroidism.

          F Monzani, L. Murri, N Caraccio … (1997)
          Alterations in muscle structure and function have been reported in overt hypothyroidism, with decreased activity of enzymes involved in anaerobic and oxidative glucose metabolism. To test whether similar changes in muscle energy metabolism are present in subclinical hypothyroidism (sHT), we studied 12 patients with sHT who complained of mild neuromuscular symptoms. The control group included 10 sex- and age-matched healthy volunteers. Skeletal muscle lactate and pyruvate production were determined in the resting state and during dynamic arm exercise. During exercise, blood lactate was significantly higher in sHT patients than in controls from the third exercise step onward (P = 0.02 at 30%, p = 0.008 at 40%, and P = 0.002 at 50% of maximal voluntary contraction). Moreover, the mean increment in blood lactate during exercise was positively related (r2 = 0.44; P = 0.02) to the duration of sHT, but not to serum levels of TSH, free T3, or free T4. No significant difference was found in blood pyruvate concentrations between the two groups at baseline or during exercise. Thus, the lactate/pyruvate ratio curve paralleled the lactate curve in patients as well as controls. We conclude that muscle energy metabolism is impaired in sHT in rough proportion to the known duration of the disease. Early L-T4 therapy may be useful not only to provide specific treatment for such metabolic changes, but also to avoid progression to frank hypothyroidism.
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            Hypothyroidism as a cause of rhabdomyolysis.

            Francesco A. Mauri, Roger Paredes, Maria Barahona … (2002)
            We describe a patient presenting with muscular symptoms and rhabdomyolysis without any other precipitating factor, except primary hypothyroidism. After thyroxine replacement, musculoskeletal symptoms disappeared and creatine kinase concentrations decreased. Hypothyroidism is a rare cause of rhabdomyolysis, but should always be considered in a patient with an unexplained increase in creatine kinase concentrations.
            Article 0 comments Cited 21 times – based on 0 reviews     Review now
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              Rare Acute Kidney Injury Secondary to Hypothyroidism-Induced Rhabdomyolysis

              Ying Cai, Lin-Lin Tang (2012)
              Purpose Acute kidney injury (AKI) caused by hypothyroidism-induced rhabdomyolysis is a rare and potentially life-threatening syndrome. The aim of this study was to investigate the clinical characteristics of such patients. Materials and Methods We retrospectively analyzed five patients treated at the Second Affiliated Hospital of Chongqing Medical University with AKI secondary to hypothyroidism-induced rhabdomyolysis from January 2006 to December 2010. Results Of the five cases reviewed (4 males, age range of 37 to 62 years), adult primary hypothyroidism was caused by amiodarone (1 case), chronic autoimmune thyroiditis (1 case), and by uncertain etiologies (3 cases). All patients presented with facial and lower extremity edema. Three patients presented with weakness, while two presented with blunted facies and oliguria. Only one patient reported experiencing myalgia and proximal muscle weakness, in addition to fatigue and chills. Creatine kinase, lactate dehydrogenase, and renal function normalized after thyroid hormone replacement, except in two patients who improved through blood purification. Conclusion Hypothyroidism should be considered in patients presenting with renal impairment associated with rhabdomyolysis. Moreover, further investigation into the etiology of the hypothyroidism is warranted.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Endocrinol Diabetes Metab Case Rep
                Journal ID (iso-abbrev): Endocrinol Diabetes Metab Case Rep
                Journal ID (hwp): EDM
                Title: Endocrinology, Diabetes & Metabolism Case Reports
                Publisher: Bioscientifica Ltd (Bristol )
                ISSN (Electronic): 2052-0573
                Publication date (Electronic): 24 October 2016
                Publication date (Print): 2016
                Electronic Location Identifier: 16-0083
                Affiliations
                [1]Department of Internal Medicine , Ankara Numune Training and Research Hospital, Ankara, Turkey
                Author notes
                Correspondence should be addressed to Ihsan Ates; Email: dr.ihsanates@ 123456hotmail.com
                Article
                Publisher ID: EDM160083
                DOI: 10.1530/EDM-16-0083
                PMC ID: 5093402
                SO-VID: 902dd5ce-97cd-4a9f-9316-8216751e31ec
                Copyright © This is an Open Access article distributed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

                History
                Date received : 20 September 2016
                Date accepted : 23 September 2016
                Categories
                Subject: Unique/Unexpected Symptoms or Presentations of a Disease

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