Hypothyroidism is a Predisposing Factor for Fenofibrate Induced Rhabdomyolysis - Patient Report and Literature Review

Abstract

A literature survey reveals that both lipid lowering drugs - statins and fibrates--and hypothyroidism are documented causes of muscle disorders including rhabdomyolysis leading to acute renal failure. We describe a case of fenofibrate monotherapy (Lipicard) induced dialysis dependent acute renal failure in an undiagnosed hypothyroid patient which is the first case to be reported from Sri Lanka. We strongly recommend that all patients who are receiving statins and/or fibrates should be screened for occult hypothyroidism which seems to aggravate the muscle damage due to the above drugs, with or without other risk factors.

Acute renal failure due to fenofibrate monotherapy

“…Our patient had diabetes mellitus and hypertension. Hypothyroidism is another risk factor for fenofibrate induced rhabdomyolysis (8). There was not hypothyroidism in two cases reported as well as our patient.…”

Hypothyroidism Induced Severe Rhabdomyolysis in a Hemodialysis Patient

“…Hypothyroidism induced rhabdomyolysis, depending on its severity, may be complicated with acute kidney injury [14]. Rhabdomyolysis tends to occur more frequently in a portion of comorbid patients particularly receiving antihyperlipidemics (i.e., statins and fibrates) [15, 16]. In the literature, however, there have been no reports regarding hypothyroidism induced rhabdomyolysis in a hemodialysis patient.…”

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

“…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.…”

“…However, drug-induced rhabdomyolysis occurs rarely. In nearly all presented cases, a predisposing factor for rhabdomyolysis, such as high statin dose, diabetes, older age, female gender, renal disease, or hypothyroidism, is present [4, 5]. Herein, we report a 45-year-old diabetic female patient without any known prior renal disease who presented with acute renal failure that developed after fenofibrate treatment.…”