Evaluate all newly diagnosed mild-moderate renal dysfunction patients for primary hypothyroidism

Abstract

Background: Hypothyroidism often presents to nephrologists with elevated serum creatinine which may lead to unnecessary evaluation including renal biopsy. Methods: We retrospectively analysed the data of 24 patients who presented to the department of nephrology at our institute with anasarca/facial puffiness or elevated serum creatinine and diagnosed to have hypothyroidism with TSH >40 µIU/ml. Results: Twelve patients presented with generalised edema, eight patients for evaluation of deranged serum creatinine and four patients with both generalised edema and deranged serum creatinine. Age (r=0.696, p<0.001) and serum thyroid stimulating hormone (r=0.504, p=0.012) had significant positive correlation with serum creatinine whereas serum total thyroxine (r=-0.637, p<0.001) and triiodothyronine (r=-0.728, p<0.001) had significant negative correlation. Serum sodium was lower (<136 mmol/L) in eight patients. Age (r=-0.598, p<0.001), serum creatinine (r=-0.624, p<0.001), and serum thyroid stimulating hormone (r=-0.728, p=0.012) had significant negative correlation with serum sodium whereas serum total thyroxine (r=0.869, p<0.001) and triiodothyronine (r=.845, p<0.001) had significant positive correlation. Serum creatinine and sodium normalised in all after levothyroxine replacement. Conclusions: To conclude, hypothyroidism is not an uncommon cause of mild-moderate renal dysfunction and often presents to nephrologists prompting unnecessary investigations including renal biopsy. Hence, all newly diagnosed mild-moderate renal failure patients should be tested to rule out primary hypothyroidism.