Rhabdomyolysis: a rare complication of Hashimoto’s thyroiditis precipitated by statin therapy

Peringat, Jayameena; Manappallil, Robin George; Karadan, Ummer

doi:10.1136/bcr-2017-223229

Cited by 10 publications

(5 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CK, creatine kinase; Cr, creatinine. on statin therapy in the literature (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). These patients were characterized by male predominance (13 patients), older age (> 50 years), prominent hypercholesterolemia, development of muscle symptoms days to weeks after starting statin therapy, and resolution of rhabdomyolysis with the correction of hypothyroidism.…”

Section: Discussionmentioning

confidence: 99%

Case report: Rhabdomyolysis and kidney injury in a statin-treated hypothyroid patient–kill two birds with one stone

et al. 2022

View full text Add to dashboard Cite

Statin treatment for hypercholesterolemia may cause reversible rhabdomyolysis and acute kidney injury in susceptible patients. However, persistent rhabdomyolysis and acute kidney injury following discontinuation of statins require careful evaluation of the underlying causes to avoid missing a curable disease. We describe a 50-year-old woman with hypercholesterolemia [total cholesterol 345 mg/dl, low-density lipoprotein cholesterol (LDL-C) 266 mg/dL] on atorvastatin therapy (40 mg daily) for 1 month that presented with myalgia and muscle weakness. Relevant laboratory studies revealed persistent higher hypercholesterolemia with total cholesterol (312 mg/dL), high creatine kinase (CK) (5,178 U/L), and high creatinine levels (1.5 mg/dL) without dysmorphic red blood cells and proteinuria. Despite the cessation of statin therapy, serum CK level increased to 9,594 U/L, and creatinine remained at 1.5 mg/dL. A thorough work-up to assess potential underlying causes indicated low T3 and free T4 and high thyroid-stimulating hormone (TSH) levels, consistent with hypothyroidism. With aggressive thyroxine replacement for 1 month, all of the clinical features, along with elevated serum CK and creatinine levels, were completely resolved. This case highlights the fact that hypothyroidism must be kept in mind as a potential cause of concomitant myopathy and kidney injury, especially in patients with statin-resistant hypercholesterolemia.

show abstract

Section: Discussionmentioning

confidence: 99%

Case report: Rhabdomyolysis and kidney injury in a statin-treated hypothyroid patient–kill two birds with one stone

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The muscle involvement in hypothyroidism ranges from asymptomatic CK elevation to proximal myopathy mimicking inflammatory myositis and rarely, frank rhabdomyolysis [ 6 , 7 ] and necrotising myopathy [ 8 ]. Furthermore, patients with primary hypothyroidism are more at risk of developing statin-induced myopathy [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Severe Hypothyroidism Complicated by Myopathy and Neuropathy with Atypical Demyelinating Features

Brzozowska

Banthia

Thompson

et al. 2021

Case Reports in Endocrinology

View full text Add to dashboard Cite

Autoimmune hypothyroidism may result in a wide range of neuromuscular disorders. The frequently observed neurological manifestations of acquired hypothyroidism include mild to moderate myopathy and sensorimotor neuropathy, which usually resolve by clinical and electrophysiological criteria, in adults treated with thyroid hormone replacement. We report a case of a 30-year-old male with severe hypothyroidism secondary to chronic autoimmune thyroiditis who presented with a 2-year history of progressive fatigue, upper and lower limb weakness, myalgia, and intermittent paraesthesia. His neurological exam demonstrated proximal and distal muscle weakness, lower limb areflexia, and relatively intact sensory modalities. The patient’s biochemistry revealed unusually and profoundly raised the thyroid stimulating hormone (TSH) level of 405.5 mIU/L (reference range (RR): 0.27–4.2 mIU/L) and creatine kinase (CK) level of 20,804 U/L (RR: 45–250 U/L), while his nerve conduction studies (NCS) demonstrated severe sensorimotor polyneuropathy with both axonal and demyelinating features. Thyroid hormone replacement therapy over the first 3 months resulted in biochemical normalization of his extremely deranged thyroid function tests (TFTs) and CK levels. At 12 months, despite maintaining euthyroidism and noticeable improvement in strength, his nerve conduction studies (NCS) demonstrated the continued absence of distal motor and sensory responses in his lower limbs with only partial improvement in sensory amplitudes and conduction velocities in his upper limbs. This report highlights the potential for severe neuromuscular consequences from advanced and chronic autoimmune hypothyroidism. The patient’s myopathy has resolved over a period of three months with prompt normalization of CK levels. Concerningly, the patient achieved significant but incomplete recovery from his mixed axonal and demyelinating neuropathy with residual mild distal weakness and areflexia in his lower limbs and persistent motor and sensory impairments on his NCS. The severity and incomplete resolution of our patient’s neurological manifestations emphasize the importance of early diagnosis and the need for prompt therapeutic intervention for hypothyroidism.

show abstract

“…Hashimoto thyroiditis or have not received treatment long time. In these patients, the elevations of blood urea nitrogen and serum creatinine improve within days after starting levothyroxine treatment (5,6). For this reason, thyroid function should also be evaluated in routine controls in patients with acute renal failure (5).…”

Section: Rhabdomyolysis and Kidney Damage Are Seen In Patients Who Armentioning

confidence: 99%

“…After levothyroxine treatment for hypothyroidism, her renal failure regressed within days. Although the physiopathology of kidney disease secondary to hypothyroidism is not known, decreased kidney mass, decreased peripheral vascular resistance and decreased cardiac output-related kidney blood supply, renin-angiotensin-aldosterone system and decreased response to sympathetic activation, and rhabdomyolysis are considered as possible causes responsible for the development of acute kidney injury (6). In our patient, we could not detect any signs of renal parenchymal disease such as hematuria and proteinuria, or obstruction to explain the reason of AKI.…”

Section: Rhabdomyolysis and Kidney Damage Are Seen In Patients Who Armentioning

confidence: 99%

Difficulties in Management of Acute Kidney Injury in Diabetic Ketoacidosis Case with Multiple Autoimmune Diseases

Sarıkaya¹

2021

Erciyes Med J

View full text Add to dashboard Cite

show abstract

Rhabdomyolysis: a rare complication of Hashimoto’s thyroiditis precipitated by statin therapy

Cited by 10 publications

References 9 publications

Case report: Rhabdomyolysis and kidney injury in a statin-treated hypothyroid patient–kill two birds with one stone

Case report: Rhabdomyolysis and kidney injury in a statin-treated hypothyroid patient–kill two birds with one stone

Severe Hypothyroidism Complicated by Myopathy and Neuropathy with Atypical Demyelinating Features

Difficulties in Management of Acute Kidney Injury in Diabetic Ketoacidosis Case with Multiple Autoimmune Diseases

Contact Info

Product

Resources

About