Endocrine Abstracts

Introduction: During nephrotic syndromes, thyroid function abnormalities may be observed. Hypothyroidism due to loss of thyroid hormones or their binding proteins can be seen but remains a rare complication of nephrotic syndrome. We report the case of 22 year old patient admitted for massive proteinura with nephrotic syndrome that was complicated with hypothyroidism.

Case report: We report the case of 22 year old patient who presented with generalized edema. The patient was diagnosed with nephrotic syndrome with massive proteinuria at 15 g/24 h. He was found to have a hypothyroidism with a TSH level at 6 mUI/l. Thyroid ultrasound was normal with negative anti-thyroperoxidase antibodies. A kidney biopsy revealed features consistent with minimal change renal disease. Given the massive proteinuria and etiology investigations of hypothyroidism that were negative, the patient was not put on thyroxine therapy. The evolution was favorable with regression of proteinuria to 5 g/24 under symptomatic treatment and normalization after a month as well as thyroid function.

Discussion: Excessive loss of urinary proteins due to nephrotic syndrome leads to loss of albumin and thyroxine binding globulin (TBG) through urine and can affect thyroid function. It also damages renal tubules and reduces the reabsorption of low-molecular-weight proteins, including free thyroid hormones. In most cases, the loss of thyroid hormones is compensated by an increase in TSH. Hypothyroidism, which remains a rare event during nephrotic syndrome, is seen mainly in massive and prolonged proteinuria.

Conclusion: The occurrence of hypothyroidism in nephrotic syndrome in adults is rarely described. Its exact prevalence is not well known. It seems useful to systematically assess thyroid function in the nephrotic syndrome especially if the proteinuria is massive and prolonged.