Fenofibrate-induced rhabdomyolysis in a patient with chronic kidney disease: an unusual presenting feature of hypothyroidism

Sousa, Alessandra Alves de; Kronit, Hans Stauber; Neves, Francisco de Assis Rocha; Amato, Angélica Amorim

doi:10.1590/s0004-27302009000300015

Cited by 11 publications

(4 citation statements)

References 28 publications

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“…At least 79% of patients with hypothyroidism have muscle weakness, cramps, and myalgia complaints and occasionally they may develop rhabdomyolysis . Interestingly, there are some reports of rhabdomyolysis in hypothyroid patients treated with PPAR‐ α activators . However, as suggested by the results of our study, 12‐week treatment of subclinical hypothyroid patients or women on thyroxine replacement therapy with 200 mg of fenofibrate daily was safe in almost all individuals.…”

Section: Discussionmentioning

confidence: 52%

“…Very little is known about the effect of fibrates in patients with thyroid dysfunction. The conducted to date studies concentrated almost exclusively on the cases of PPAR‐ α activator‐induced rhabdomyolysis in individuals with thyroid hypofunction . Therefore, the aim of this study was to compare fenofibrate action on plasma lipid levels and on plasma levels of other variables considered cardiovascular risk factors between patients with and without hypothyroidism.…”

Section: Introductionmentioning

confidence: 99%

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Different Effects of Fenofibrate on Metabolic and Cardiovascular Risk Factors in Mixed Dyslipidemic Women With Normal Thyroid Function and Subclinical Hypothyroidism

Krysiak

Gilowski

Szkróbka

2014

Cardiovascular Therapeutics

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SUMMARYAims: Subclinical hypothyroidism is suggested to increase cardiovascular risk. No previous study compared the effect of any fibrate on plasma levels of lipids and other cardiovascular risk factors in patients with different thyroid function status. Methods: The study included three age-, weight-and lipid-matched groups of women with mixed dyslipidemia in different thyroid function status: patients with untreated subclinical hypothyroidism (group 1, n = 18), women with treated hypothyroidism (group 2, n = 15), and subjects without thyroid disorders (group 3, n = 19). Plasma lipids, glucose homeostasis markers, as well as plasma levels of uric acid, high-sensitivity C-reactive protein (hsCRP), homocysteine, and fibrinogen were determined before and after 12 weeks of fenofibrate therapy. Results: Despite similar plasma lipid levels, mixed dyslipidemic patients with untreated hypothyroidism had decreased insulin sensitivity, as well as higher circulating levels of uric acid, hsCRP, homocysteine, and fibrinogen in comparison with the other groups. The effect of fenofibrate on plasma lipids and, with the exception of homocysteine, on circulating levels of all investigated risk factors was stronger in patients from groups 2 and 3 than in patients from group 1. Conclusions: The obtained results indicate that the effect of fenofibrate on plasma lipids and circulating levels of cardiovascular risk factors is partially related to thyroid function. They also suggest that to improve the strength of fibrate action in dyslipidemic patients with subclinical hypothyroidism, they should be administered together with L-thyroxine.

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Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Different Effects of Fenofibrate on Metabolic and Cardiovascular Risk Factors in Mixed Dyslipidemic Women With Normal Thyroid Function and Subclinical Hypothyroidism

Krysiak

Gilowski

Szkróbka

2014

Cardiovascular Therapeutics

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“…Fifteen of them are summarized in Table 2 [1, 4–16]. The risk for serious muscle toxicity appears to be increased in elderly patients and in patients with diabetes [5, 11, 15], renal failure [4, 7, 16], or hypothyroidism [4, 5, 7, 11, 13, 15, 16]. For the patient we present here, tests done 2 months previously found normal results for renal function, thyroid function, and anti-TPO antibody levels.…”

Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis-Induced Acute Renal Failure Following Fenofibrate Therapy: A Case Report and Literature Review

Danış

Akbulut

Özmen

et al. 2010

Case Reports in Medicine

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Fenofibrate, a fibric acid derivative, is used to treat diabetic dyslipidemia, hypertriglyceridemia, and combined hyperlipidemia, administered alone or in combination with statins. Rhabdomyolysis is defined as a pathological condition involving skeletal muscle cell damage leading to the release of toxic intracellular material into circulation. Its major causes include muscle compression or overexertion; trauma; ischemia; toxins; cocaine, alcohol, and drug use; metabolic disorders; infections. However, rhabdomyolysis associated with fenofibrate is extremely rare. Herein we report a 45-year-old female patient who was referred to our department because of generalized muscle pain, fatigue, weakness, and oliguria over the preceding 3 weeks. On the basis of the pathogenesis and clinical and laboratory examinations, a diagnosis of acute renal failure secondary to fenofibrate-induced rhabdomyolysis was made. Weekly followups for patients who are administered fenofibrate are the most important way to prevent possible complications.

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“…2 ). In dem von de Sousa et al[ 16 ] veröff entlichtem Fallbericht erfolgte die Einnahme von Fenofi braten. TPO Ak war deutlich erhöht, während in unserem Fall kein erhöhter Titer für anti-TPO Ak nachweisbar war.…”

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Rhabdomyolyse bei Hashimoto-Thyreoiditis - Fallbericht und Literaturübersicht

et al. 2013

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Zusammenfassung Bei klinisch vorhandenen Muskelschmerzen, einer massiven Erh?hung der CK im Serum und Myoglobulinurie liegt eine Rhabdomyolyse vor. Ursachen k?nnen neben Trauma, myotoxischen Medikamenten, Alkohol-, Drogenkonsum und Infektionen auch endokrine Stoffwechselst?rungen oder Autoimmunerkrankungen sein. Auftretende Komplikationen sind beispielsweise akutes Nierenversagen und Kompartmentsyndrom. Das fr?hzeitige Erkennen der Ursache und deren Behebung und eine ad?quate symptomatische Therapie verhindern schwerwiegende Komplikationen. Wir pr?sentieren den klinischen Fall einer 44-j?hrigen Patientin, die sich mit dem Leitsymptom Myalgie vorstellte. Bei CK-Werten bis 8?830?IU/l. Begleitend zeigte sich ein Perikarderguss, ein Myx?dem der Stimmlippen und im Verlauf trat eine Verschlechterung der Nierenfunk?tion auf. Unter L-Thyroxin Substitution und Volumensubstitution waren die Beschwerden r?ckl?ufig. Als Ursache diagnostizierten wir eine Hashimoto-Thyreoiditis. Eine isolierte Hypothyreose als Ursache einer Rhabdomyolyse ist selten. In der Literatur finden sich h?ufig ausl?sende Kofaktoren in der Anamnese, vor allem eine Therapie mit HMG-CoA-Reduktase-Hemmern. Bei Myalgien und CK-Erh?hung als Leitsymptom muss als Ursache neben anderen Ausl?sern an eine Hashimoto-Thyreoiditis gedacht werden. Durch Hormonsubstitution und ad?quate symptomatische Therapie k?nnen Komplikationen vermieden werden.

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Fenofibrate-induced rhabdomyolysis in a patient with chronic kidney disease: an unusual presenting feature of hypothyroidism

Cited by 11 publications

References 28 publications

Different Effects of Fenofibrate on Metabolic and Cardiovascular Risk Factors in Mixed Dyslipidemic Women With Normal Thyroid Function and Subclinical Hypothyroidism

Different Effects of Fenofibrate on Metabolic and Cardiovascular Risk Factors in Mixed Dyslipidemic Women With Normal Thyroid Function and Subclinical Hypothyroidism

Rhabdomyolysis-Induced Acute Renal Failure Following Fenofibrate Therapy: A Case Report and Literature Review

Rhabdomyolyse bei Hashimoto-Thyreoiditis - Fallbericht und Literaturübersicht

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