Rhabdomyolysis Accompanying Thyroid Crisis: An Autopsy Case Report.

Abstract

Rhabdomyolysis is occasionally associated with metabolic disorders such as diabetic coma, severe electrolyte disturbances and myxedema coma. We describe rhabdomyolysis accom panying thyroid crisis. A 50-year-old man with Graves' disease developed rhabdomyolysis, congestive heart failure and hepatic failure during the course of thyroid crisis and then died of acute renal failure. Postmortem examination revealed rhabdomyolysis in the cardiac and psoas muscles, old myocardial infarction, hepatic centrilobular necrosis, renal cortical necrosis, and follicular hyperplasia in the thyroid. Circulatory collapse and dehydration under excessive hypermetabolic state presumably suppressed the source of energy and oxygen for muscle cells, leading to cellular damage.

Thyroid Crisis following Interstitial Nephritis

“…Graves' disease is often accompanied with renal dysfunction such as immune complex-mediated nephritis by thyroid antigens (5,6) and acute renal failure by rhabdomyolysis following thyroid crisis (7,8). During propylthiouracil treat-ment, there are cases reports of ANCA-related glomerulonephritis (9,10) and propylthiouracil-induced tubulointerstitial nephritis (11,12).…”

Does Myocardial Necrosis Occur in Rhabdomyolysis?

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The presumed cause of their rhabdomyolysis was as follows: alcohol or illicit drugs in 9 patients, 9,12,16,19,20 trauma or extreme heat in 8, 10,11,13,14,22,24 medications in 7, 7,8,15,17,18,23 and thyroid storm in 1. 6 In the remaining patient, the cause was unclear. 21 Serum creatine kinase (CK) levels varied from 115 to 762,000 U/L; the CK-MB fraction, obtainable in 9 cases, [7][8][9]12,14,15,21,23,24 ranged from 0 to 7,888 ng/mL.…”

“…21 Serum creatine kinase (CK) levels varied from 115 to 762,000 U/L; the CK-MB fraction, obtainable in 9 cases, [7][8][9]12,14,15,21,23,24 ranged from 0 to 7,888 ng/mL. The ECG was normal in 3 patients, 15,19 displayed evidence of old myocardial infarction in 2 6,13 and acute myocardial infarction in 1, 22 and exhibited a variety of nonspecific changes in the others. Serum troponin I levels were elevated in 9 of 10 patients.…”

“…Eight patients died, and all 8 underwent autopsy. 6,8,12,[16][17][18]22 In 7 of the 8, myocardial necrosis was evident; the other report did not describe the heart. 8 Information on the coronary arteries was available in 3 patients, each of whom had clot-free vessels.…”

“…So we focused next on the known markers of myocardial damage accessible in these 7 patients. Three of them had ECGs (aforementioned) that were consistent with old 6,13 or new 22 myocardial infarction. One of these 3, 13 as well as 2 others, 8,17 had elevated serum troponin I levels.…”