Hypothyroidism and Hyponatremia: Rather Coincidence Than Causality

Wolf, Peter; Beiglböck, Hannes; Smaijs, Sabina; Wrba, Thomas; Rasoul‐Rockenschaub, Susanne; Marculescu, Rodrig; Gessl, Alois; Luger, Anton; Winhofer, Yvonne; Krebs, Michael

doi:10.1089/thy.2016.0597

Cited by 14 publications

(13 citation statements)

References 19 publications

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“…Sun et al also reported that hyponatremia was not a common finding among their population with extreme TSH elevations [15]. This was also supported by Wolf et al who reported that the co-occurrence of hyponatremia with hypothyroidism is probably a coincidence and attributable to other causes [16]. Although chronic hypothyroidism was linked to a reduction in the levels of the antidiuretic hormone, inducing hyponatremia, recent evidence also supports these findings that causes other than hypothyroidism contribute to the development of hyponatremia, which can only occur in cases of severe hypothyroid disease and myxedema [17].…”

Section: Electrolytesmentioning

confidence: 70%

Common Electrolyte and Metabolic Abnormalities Among Thyroid Patients

Alqahtani¹,

Almagsoodi²,

Alshamrani³

et al. 2021

Cureus

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The prevalence of thyroid diseases is high in the general population and causes serious abnormalities and disorders that can affect the quality of life. Many complications can result from poor or inappropriate management of the disease, leading to serious cardiovascular and metabolic complications. In the present review study, we aim to discuss the effect of thyroid diseases on metabolic and electrolyte abnormalities and the potential correlation with some common disorders. Evidence from previous studies has demonstrated that thyroid dysfunctions hugely affect the metabolism of glucose in the bodies of the affected patients, which can lead to the development of both type 1 and 2 diabetes mellitus (DM). Hyperthyroidism can lead to the development of impaired glucose tolerance and secondary diabetes mellitus. These include an increased glycogenolysis and gluconeogenesis process, increased intestinal absorption of glucose, and secondary ketogenesis and lipolysis, which will subsequently affect the functions of the insulin-secreting cells of the pancreas. Evidence showed that thyroid diseases are associated with the development of obesity and metabolic syndrome, and the management for these modalities should involve prior management of underlying thyroid diseases. Efforts should be made to adequately manage these cases with concomitant approaches to achieve the best clinical outcomes.

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Section: Electrolytesmentioning

confidence: 70%

Common Electrolyte and Metabolic Abnormalities Among Thyroid Patients

Alqahtani¹,

Almagsoodi²,

Alshamrani³

et al. 2021

Cureus

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show abstract

“…Hyponatremia in isolated hypothyroidism is rare, and mostly the consequence of primary hypothyroidism. Proposed mechanism for the hyponatremia in hypothyroid patients is the elevation of antidiuretic hormone together with mild renal impairment [20][21][22][23]. Symptomatic hyponatremia should be urgently solved with intravenous 3% saline solution according to current guidelines, having in mind that too fast elevation of sodium can result in pontine myelinolysis [1,24,25,26].…”

Section: Discussionmentioning

confidence: 99%

Forgotten cause of severe hyponatremia

et al. 2021

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Introduction. Sheehan syndrome (ShS) is (pan)hypopituitarism because of postpartum pituitary infarction due to massive obstetrical hemorrhage. Enlargement of the pituitary gland, smaller sellar region, disseminated intravascular coagulation (DIC) or autoimmunity are predisposing factors. The absence of lactation after labor and inability to resume the menstrual cycle later are presenting symptoms. Some of patients with Sheehan's syndrome have a sudden onset of severe hypopituitarism immediately after labor, most often in the form of severe hyponatremia. Central adrenal insufficiency is the most usual cause of hyponatremia, although in some cases the syndrome of inappropriate antidiuretic hormone secretion has been also described. Case outline. The female patient, 39-year-old, was admitted to the Intensive Care Unit due to severe hyponatremia with neurological symptoms (Na 103 mmol/L, Cl 72 mmol/L, K 3.7 mmol/L), and absence of lactation. Previously, on the sixth postpartum day, she was admitted to the Obstetrics and Gynecology Clinic due to severe headache, nausea, vomiting, and blurred vision. The symptoms persist from the labor, which was complicated with severe hemorrhage (1000 ml) due to obstetric complications. Treatment began with the 3% hypertonic saline solution with restriction of fluid intake. In regard to panhypopituitarism, replacement therapy with hydrocortisone and levothyroxine was initiated. Diabetes insipidus was excluded. Growth hormone replacement therapy and combination of progesterone and progestogens was started during follow-up. Conclusion. Early diagnosis of Sheehan's syndrome is essential. Pituitary insufficiency in these patients has a great diversity in presentation, that can sometimes result in coma and death.

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“…A retrospective study by Berndt et al (2015) for investigating any possible link of hyponatremia in hypothyroid patients showed that deficiency of thyroid hormone had no effect on hyponatremia occurrence [16]. Another retrospective analysis by Wolf et al (2017) showed that decreased sodium levels in hypothyroid patients were often secondary to other medical conditions [17]. A prospective study by Hammani et al (2013) in thyroid cancer patients concluded that there was no association between hyponatremia and hypothyroidism [18].…”

Section: Discussionmentioning

confidence: 99%

Effect of Optimal Thyroid Replacement Therapy on Chronic Hyponatremia with Focused Review of the Evidence, Mechanisms, and Clinical Implications

Chaudhary

Warraich

et al. 2019

Cureus

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We present an unusual case of hyponatremia in an ambulatory hypothyroid patient and review related published literature on PubMed including, original articles, reviews and case reports that describe or refute the association and mechanism for the development of hyponatremia in hypothyroidism.A 50-year-old female presented in ambulatory clinic with complaints of bilateral hand swelling, fatigue, dizziness, and unsteadiness while walking. Laboratory investigations revealed that she had hypothyroidism and hyponatremia. Thyroid hormone replacement therapy resulted in resolution of hypothyroidism symptoms as well as hyponatremia. A comprehensive search of related literature regarding the development of chronic hyponatremia in hypothyroidism revealed two schools of thought, which we have summarized in this report.Based on our observations, we conclude that due to overlap in symptoms of hyponatremia and neurological manifestations of hypothyroidism, it is imperative to screen hypothyroid patients for underlying hyponatremia and treat accordingly in order to prevent long-term complications of chronic hyponatremia. Hyponatremia secondary to hypothyroidism resolves with appropriate thyroid hormone replacement therapy, which shows convincing evidence of an association between the two entities.

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Hypothyroidism and Hyponatremia: Rather Coincidence Than Causality

Abstract: The results suggest that hypothyroid patients with moderate to severe hyponatremia often have other potential explanations for their low serum Na concentrations in routine care.

Cited by 14 publications

References 19 publications

Common Electrolyte and Metabolic Abnormalities Among Thyroid Patients

Common Electrolyte and Metabolic Abnormalities Among Thyroid Patients

Forgotten cause of severe hyponatremia

Effect of Optimal Thyroid Replacement Therapy on Chronic Hyponatremia with Focused Review of the Evidence, Mechanisms, and Clinical Implications

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