Endocrine Abstracts

Introduction: Renal impairment associated with hypothyroidism without any other clear underlying cause is relatively rare. We report a case with severe hypothyroidism admitted with acute renal failure.

Case report: A 72 years old female patient was addmitted to the emergency department with progressively worsening complaints of fatigue, somnolence, and swellings all over her body for the last 3 weeks. Initial laboratory examination revealed acute renal failure (BUN: 150 mg/dl, creatinine: 5.03 mg/dl) after which she was hospitalized. Past history disclosed no previous thyroid disease, thyroid medication, or thyroid surgery. History about any renal disease was also unrevealing. She did not receive any statin or fibrate therapy. She only received ramipril for hypertension for about 15 years. Physical examination was notable for stuporous and dysoriented state, periorbital, facial, and lower extremity edema. She was not hypothermic or hypotensive. Further laboratory evaluation showed severe hypothyroidism (TSH >100 mIU/ml, fT₄ <0.40 ng/dl, fT₃ <1.00 pg/ml) and high creatine phosphokinase levels with normal MB fraction suggesting rhabdomyolysis. Thyroid autoantibody levels were positive. Autoantibody screening for systemic autoimmune disease and complement levels were normal. Urinalysis was negative for blood and protein in the urine. Ultrasonographic evaluation of urinary system and doppler ultrasonography of arteriovenous system of the kidneys were unremarkable. A randomly measured cortisol level was 20.2 μg/dl and she was started on glucocorticoid therapy. Replacement with levothyroxine was started soon after with mild increments under close cardiac monitorization. Supportive therapy included parenteral hydration and ampiric antibiotics. Her symptoms improved, BUN and creatinine levels returned to normal after seventh day of treatment. Glucocorticoid therapy was rapidly tapered and stopped after second cortisol measurement (11 μg/dl morning).

Conclusion: Hypothyroidism may be a cause or triggering factor of acute renal failure. Thyroid function tests may become part of the routine list to go through as a cause of acute renal failure.