Abstract
Objectives: Rhabdomyolysis is a potentially life-threatening syndrome. Hypothyroid patients may present with myopathy and mild elevation of CK levels; however, overt rhabdomyolysis is extremely rare, and few cases have been described. Hypothyroidism should be considered in patients presenting with renal impairment associated with rhabdomyolysis. Case report: A 24-year-old young man with accidently discovered hypothyrodism on admission presented with generalized myalgia, profound proximal muscle weakness of the bilateral lower extremities, anuria, vomiting and dark colored urine lasting for three days. Neurological examination revealed bilateral marked weakness and tenderness of muscles of both lower and upper extremities. Urine had dark red appearance and urinalysis showed blood reaction with dipstick test, but there were no erythrocytes on microscopic examination. Serum creatine phosphokinase and myoglobin levels were elevated. Thyroid stimulating hormone (TSH) levels were high, and Free Thyroxine (T4) and Triiodothyronine (T3) levels were low, renal function tests showed acute kidney injury. Other causes of rhabdomyolysis such as muscular trauma, drugs, toxins, infections, vigorous exercise, and electrolyte abnormalities were excluded. Hemodialysis was administered for five sessions. After L-thyroxine therapy, thyroid function tests normalized, muscle strength improved, serum muscle enzyme levels returned to normal levels, and renal function tests recovered. Conclusion: Hypothyroidism should be considered in patients presenting with renal impairment associated with rhabdomyolysis.
Highlights
Rhabdomyolysis is a potentially life-threatening syndrome characterized by muscle necrosis and the release of intracellular muscle contents into the circulation
Nontraumatic rhabdomyolysis is elusive; it often occurs without symptoms and is diagnosed when creatine kinase (CK) levels are elevated in the initial stages of the disease
Hypothyroidism should be considered in patients presenting with renal impairment associated with rhabdomyolysis and emphasize that the causes of hypothyroidism warrant further investigation [4]
Summary
Rhabdomyolysis is a potentially life-threatening syndrome characterized by muscle necrosis and the release of intracellular muscle contents into the circulation. The etiology of rhabdomyolysis can be classified into traumatic and nontraumatic causes. The latter is associated with alcohol and drug abuse, seizures, strenuous exercise, muscle hypoperfusion, hyperthermia, electrolyte disturbances, diabetic coma, severe infection and hypothyroidism, among others [1]. Acute kidney injury (AKI) and severe electrolyte derangements are life threatening, and are accompanied by extreme elevations in CK levels [2]. Hypothyroid patients may present with myopathy and mild elevation of CK levels; overt rhabdomyolysis is extremely rare, and few cases have been described [3]. Hypothyroidism should be considered in patients presenting with renal impairment associated with rhabdomyolysis and emphasize that the causes of hypothyroidism warrant further investigation [4]. We report a rare presentation of AKI secondary to hypothyroidism-induced rhabdomyolysis
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