Smokovski, Ivica (2020) Severe Hyponatremia Following Rhabdomyolysis And Acute Renal Failure In A Young Patient With Undiagnosed Hypothyroidism. In: AACE 2020.
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Abstract
INTRODUCTION Severe hypothyroidism is often associated with myopathy which is most often limited to myalgia,
muscle stiffness and cramps, with sometimes moderately elevated levels of muscle enzymes. Occasionally patients will develop severe myopathy and renal failure from rhabdomyolysis . However, rhabdomyolysis due to hypothyroidism is very rare. Another rare complication of hypothyroidism is hyponatremia. Cases of extreme hyponatremia from hypothyroidism are reported to be rare. We report a case of both rhabdomyolysis and unprecedented
hyponatremia occurring with hypothyroidism LAB VALUES TSH (mIU) /75. at admission. Latest result (Nov 2019) is 4.1
Cr micromol /l 135 (1.53 mg/dl) ACTH pg/ml 1581 latest result 110 (Nov 2019) PRL (ng/ml) 22. Lab results were obtained through Abbott Architecture c4000. CASE
DESCRIPTION We present a case of a young male patient, aged 36, with medical history of rhabdomyolysis resulting in acute renal failure (hypothyroid myopathy in retrospect). He initially presented with muscle pain and weakness and was diagnosed with a generalized demyelinating sensorimotor polyneuropathy. He was
treated with intermittent parenteral corticosteroid therapy. His weakness and myalgia worsened and he was diagnoses with rhabdomyolysis resulting in renal insuffiency As he continued to deteriorate, a TSH level was obtained and found to be significantly elevated. On exam, the patient was drowsy, but alert. Substitution
therapy with levothyroxine was immediately started, per protocol. His sodium levels were constantly decreasing (from 115 to 98 mmol/L) despite the administration of hypertonic sodium chloride and fluid restriction.
At that time, parenteral glucocorticoid therapy in high doses was introduced, as hyperkalemia and the previous corticosterod treatment lead us to diagnose iatrogenic adrenal insufficiency. In the midst of the patient’s lowest sodium levels, he had an episode of headache, na usea, vomiting and hypothermia. The patient’s serum osmolality was low 196.38mOsm/kg), but his urine osmolality (412.88mOsm/kg) and urine electr oly tes were all within the normal ranges ( euvolemic hypotonic hyponatremia). As his fT4 levels started to improve, his overall clinical condition improved significantly
DISCUSSION Muscle injury is a common complication of hypothyroidism but rarely leads to rhabdomyolysis. Significant hyponatremia is also a rare complication
of hypothyroidism. Although other previous investigators have minimized the risk of hyponatremia and hypothyroidism, several oth ers have found it
to be a significant risk. This study shows the need to consider hypothyroidism in patients with significant muscle injury and or hyponatremia as a
possible cause. This case was also complicated by concomitant iatrogenic adrenal insufficiency and emphasizes the need to con sid er that diagnosis
to avoid exacerbating further hyponatremia
CONCLUSIONS Severe, life threatening, hyponatremia in the
setting of severe hypothyroidism was a challenge
for an entire team of experienced endocrinologists.
Although hypothyroidism is a rare cause of rhabdomyolysis, it should be suspected in patients
presenting with muscle aches and high CK
concentrations in the absence of other, causes of
rhabdomyolysis, even in the absence of its clinical
features. As soon as the diagnosis is made, thyroid hormone replacement should be promptly instigated.
| Item Type: | Conference or Workshop Item (Poster) |
|---|---|
| Subjects: | Medical and Health Sciences > Clinical medicine |
| Divisions: | Faculty of Medical Science |
| Depositing User: | Ivica Smokovski |
| Date Deposited: | 08 Jun 2020 07:38 |
| Last Modified: | 08 Jun 2020 07:38 |
| URI: | https://eprints.ugd.edu.mk/id/eprint/24107 |
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