Endocrine Abstracts

Introduction: Hypothyroidism can cause various degrees of muscular disorders. It can lead to symptoms such as myalgia, weakness, fatigue and in rare cases to extreme muscular damage such as rhabdomyolysis, a potential life-threatening complication. We present the case of a 53 years old patient with acute renal failure due to rhabdomyolysis from severe hypothyroidism.

Case description: The patient, a male from Albania was first admitted to the Emergency Room with complaints of severe weakness and profuse sweating. He was hospitalised in the Department of Nephrology with Acute Renal Failure from Rhabdomyolysis probably from lipid lowering medications. The patient had a short history of treatment with Statins. He was discharged after a week with moderate elevated creatine kinase level (CK 2000 UI/l) and the treatment with Statins was interrupted. The patient was re hospitalised, two weeks after being discharged with the same symptoms and elevated muscular enzymes. Blood tests were as followed: Urea 34 mg/dl, Creatinine 1.7 mg/dl, LDH 725 U/l, CK 5130 U/l. At the moment, he was not taking any lipid lowering medication and he did not have any history of extreme exercise. He had a history of several months of stiffness, feeling cold, swelling and inexplicable weight gain. Because of these clinical manifestation, a level of thyroid stimulus hormone (TSH) and anti-thyroid peroxidase antibodies (anti – TPO) were taken and they both were very high [TSH > 75 U/ml (0.4–4 U/ml) and anti TPO–1050 U/ml (<60 U/ml)]. The diagnose of hypothyroidism was later confirmed with ultrasound of the thyroid gland where it was evident a heterogeneous structure, an aspect favouring Hashimoto Thyroiditis.

The patient was started therapy with Levothyroxine and the level of muscular enzymes declined, as well as his symptoms.

Conclusion: Hypothyroidism is a rare but potential cause of rhabdomyolysis when other risk factors are excluded. In order to prevent complications from rhabdomyolysis such as acute renal failure, we should always consider thyroid gland function when elevated muscular enzymes are present alongside symptoms of hypothyroidism.