Hypothyroidism as a Cause of Rhabdomyolysis.

Barahona, María José; Mauri, Albert; Sucunza, Nuria; Paredes, Roger; Wägner, Ana M.

doi:10.1507/endocrj.49.621

Cited by 63 publications

(61 citation statements)

References 5 publications

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“…The exact cause of rhabdomyolysis in hypothyroidism has not as yet been fully clarified; the widely accepted hypothesis is that impaired glycogen lysis or impaired mitochondrial oxidative metabolism in hypothyroidism may be responsible for rhabdomyolysis (1,2,3). In our case, hypothyroidism was the cause of rhabdomyolysis because of lack of other etiologic agents resulting in rhabdomyolysis.…”

Section: Discussionmentioning

confidence: 62%

Rhabdomyolysis case based on hypothyroidism

Ateş¹

2016

EJEA

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SummaryHypothyroidism is a wide clinical spectrum disorder and only a few cases in literature show this. Rhabdomyolysis and acute renal impairment can be seen concurrently in a hypothyroid state. We report a case of severe hypothyroidism with poor drug compliance leading to rhabdomyolysis and acute kidney injury. ID: 16-0083; October 2016 DOI: 10.1530 Correspondence should be addressed to I Ates Email dr.ihsanates@hotmail.com Learning points:• Hypothyroidism is a rare cause of acute kidney injury.• In this case report, we studied a rare occurrence of acute renal impairment due to hypothyroidism with poor drug compliance, which induced rhabdomyolysis.• Our report emphasized that thyroid status should be evaluated in patients with unexplained acute renal impairment or presenting with the symptoms of muscle involvement. Case presentationA 53-year-old male was admitted to a hospital with 15 days history of dyspnoea, weakness and oliguria, and muscle pain. His medical history included pulmonary thromboembolic, hypertension and cardiac arrhythmia. He had undergone total thyroidectomy for papillary thyroid cancer two years ago. His medication consisted of metoprolol, enoxaparin and l-thyroxine with no use in the past 4 weeks. Physical examination revealed dry and pale skin and slow speech. His pulse rate was 55 beats/minute and blood pressure was 130/90 mm Hg.Electrocardiography has shown bigemine ventricular extra systole. Laboratory investigations showed the following values: creatine phosphokinase, 1560 U/L (reference range, 52-336 U/L); creatinine, 2.1 mg/dL (0.2-1.0 mg/dL); potassium, 5.3 mEq/L (3.5-5.0 mEq/L); thyroid-stimulating hormone (TSH) 43.2 µIU/mL (0.4-4.8 uIU/mL), free thyroxine (fT4) <0.3 ng/dL (1.71-2.8 ng/dL) and free triiodothyronine (fT3) 0.48 pg/mL (1.57-4.71 pg/ mL). Haematological tests showed haemoglobin 9.4 g/dL (12-16), white cell count 9000 µL and platelet counts were in normal range. His urine was bloody in appearance and urine analysis showed blood reaction with dipstick test, but no erythrocytes were found on microscopic examination. Fraction excretion of Na and urinary Na were high (2.6% and 46 mEq/L, respectively). Renal tract ultrasonography was normal. No signs suggested the presence of an associated infectious or systemic inflammatory disease. In addition, other causes resulting in rhabdomyolysis such as muscular trauma, drugs and toxins were excluded with history and laboratory investigations. His condition was diagnosed as acute kidney injury secondary to hypothyroidism-induced rhabdomyolysis. This case was also consulted with the department of cardiology physicians who started him on metoprolol 25 mg before beginning thyroid replacement therapy. Cardiac status remained stable: l-thyroxine 25 microgram/day was prescribed, then 2 weeks later it was continued with l-thyroxine 50 microgram/day. His fluid deficiency was treated aggressively. His symptoms resolved over the following 3 weeks.

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Section: Discussionmentioning

confidence: 62%

Rhabdomyolysis case based on hypothyroidism

Ateş¹

2016

EJEA

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“…Although generally well tolerated and with few side effects, such as headache and gastrointestinal disorders, therapy with statins may be limited by side effects on the skeletal muscle such as myalgia, and rarely rhabdomyolysis. The risk of statins inducing a myopathy or rhabdomyolysis seems to increase with age, dosage ([40 mg/day), DM, liver dysfunction, chronic renal failure, a low BMI, hypothyroidism, alcohol consumption and the use of other drugs (e.g., macrolides), which may alter the pharmacokinetics in competition with cytochrome P 450 (CYP) 3A4 [2]. In fact, the percentage of muscle pathologies seems to be correlated with high doses of statins (but our patient was only taking low doses) and their plasma concentrations [3].…”

Section: Case Discussionmentioning

confidence: 99%

A pain in the arms

et al. 2013

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“…Only a few cases of rhabdomyolysis due to hypothyroidism have been reported. [1][2][3][4][5] The present case describes a patient suffering from rhabdomyolysis due to hypothyroidism, with no other precipitating factor. Diagnosis of rhabdomyolysis was carried out based on muscle weakness, grossly elevated CPK and elevated serum creatinine.…”

Section: Letters To Editor Hypothyroidism-associated Rhabdomyolysismentioning

confidence: 99%

“…[4,5] Hypothyroidism should be considered as one of the causes of rhabdomyolysis. Rhabdomyolysis manifests with muscular symptoms and severely elevated serum levels of muscle enzymes.…”

Section: Letters To Editor Hypothyroidism-associated Rhabdomyolysismentioning

confidence: 99%