Endocrine Abstracts

Background: Hashimoto thyroiditis is the most common autoimmune disease, with a marked prevalence in women. Occasionally, it may be associated with renal disease. Most described renal lesion in patients with autoimmune thyroiditis is membranous glomerulonephritis.

Case: A 32 years old Caucasian man consulted the endocrinologist with a 4 months history of progressive fatigue, headache, arthralgia, dryness of skin and increased weight of approximately 10 kg during the preceding year. Medical history was remarkable for autoimmune thyroiditis and non-treated subclinical hypothyroidism. Laboratory analysis showed severe hypothyroidism: TSH 83.98, free T4 0.48 ng/dl, positive anti-thyroid peroxidase antibodies (897 UI/ml), and hyperlipidemia: total cholesterol 8.92 mmol/l, Ldl-cholesterol 6.99 mmol/l, triglycerides 2.15 mmol/l, hypoproteinemia: total proteins 59.8 g/l, an increased Erythrocyte Sedimentation Rate (26 mm/h) and a normal creatinine level (105 μmol/l). Urinalysis showed nephrotic range proteinuria (5 g/l) and microhematuria: 2-3 blood cells/high power field. Additional serological investigations excluded a systemic disease. Therefore a renal biopsy was performed which revealed type 2 membranoproliferative glomerulonephritis (MPGN). Oral prednisone at 60 mg daily (with gradual decrease thereafter), an angiotensin-converting enzyme (Ramipril 5 mg/day) and thyroid replacement therapy (1.6 mg/kg/day) have been initiated. Following treatment the patient improved significantly both clinically and biochemically.

Conclusion: MPGN in association with autoimmune thyroiditis is a rare but severe condition. Our patient had an unusually prolonged and severe loss of thyroid function. Thyroid hormones have an important role in the maintenance of normal renal architecture and function. Renal disease secondary to hypothyroidism may be in part reversible, and it should be considered during the diagnostic evaluation of patients with hypothyroidism.