Case report: acute kidney injury secondary to mixedema accompaning rhabdomyolysis

Introduction. Acute kidney injury (AKI) occurring in
hypothyroidism is uncommon, because association
between hypothyroidism and AKI is rare.
Case report. A 64-year-old man presented with 2
weeks history of weakness, malaise, lack of appetite
and oedema. PMH: hypertension and coronary stenting. Physical examination: grayish-brown dry skin,
peripheral oedema, slow thought and speaking. Laboratory examinations: elevated CK (4158 U/l), CK-MB
(683 U/l), creatinine (675 µmol/L), urea (35 mmol/L),
AST (1671U/L), ALT (968 U/l) and LDH (1477 U/ml).
Free T4 was very low (FT4:0.08 ng/dL) and thyroidstimulating hormone was high (TSH:150 µIU/mL).
Hypothyroidism-induced rhabdomyolysis resulted in
AKI. Intravenous fluids, urinary alkalization and substitution with L-thyroxine initiation dose of 100 ug/d
and corticosteroids (urbason 2x40 mg/d) were started. All hepatotoxic agents were removed. Forced
diuresis with furosemide led to a progressive improvement in symptoms, but renal function worsened
(urea 39.6 mmol/L, creatinine 841 µmol/L, K 4.5 mmol/L)
requiring hemodialysis. Four hemodialysis sessions
and thyroxine substitution led to partial recovery of
renal function (creatinine 267 µmol/L, urea 21.9
mmol/L). Hepatic enzymes and CK fell to normal values and thyroid hormones increased (T3: 1,16 ng/dL
with TSH:50.2 µIU/mL and anti TPO:1300 U/ml).
Conclusion. Hypothyroidism related AKI due to rhabdomyolysis is reversible, if correctly diagnosed. We
describe a case of severe autoimmune hypothyroidism and AKI requiring hemodialysis, where thyroid hormone replacement resulted in partial restoration of the renal function.