Abstract
We present a patient with severe hypothyroidism complicated by paralytic ileus and acute kidney injury. A 65 year old male patient, diagnosed with hypothyroidism one year ago was transferred to our unit in a state of drowsiness and confusion. He was severely hypothyroid and had paralytic ileus and impaired renal function at the time of transfer. Hypokalaemia was present, and was likely to have contributed to the paralytic ileus and this together with dehydration was likely to have contributed to renal injury. Nonetheless, hypothyroidism is very likely to have been the principal precipitant of both these complications, and both paralytic ileus and acute kidney injury improved with thyroxine replacement. Unfortunately, the patient died unexpectedly eight days after admission to the unit.Hypothyroidism may induce de novo acute kidney injury or it may exacerbate ongoing chronic kidney disease. This rare complication is assumed to be due to the hypodynamic circulatory state created by thyroid hormone deficiency. Paralytic ileus is an even rarer fatal manifestation of hypothyroidism and is thought to be due to an autonomic neuropathy affecting the intestines that is reversible with thyroxine replacement. To our knowledge, both these complications have not been observed in a single patient so far.It is important that clinicians are aware of these rare manifestations of hypothyroidism as in most occasions, thyroxine deficiency may be missed, and treatment can reverse the complications.
Highlights
Hypothyroidism presenting with acute kidney injury is rare, with only few cases reported so far [1,2]
There are several case reports of both acute renal failure [1,5] and paralytic ileus [6,7] occurring in untreated hypothyroidism
Primary glomerular and tubular dysfunction in hypothyroidism has been observed with supportive histological evidence from biopsy specimens [8]. These were reversible with thyroxine therapy. Rhabdomyolysis, another rare but known manifestation of hypothyroidism can result in acute kidney injury but it is usually associated with another precipitating factor such as drugs or trauma [5]
Summary
Hypothyroidism presenting with acute kidney injury is rare, with only few cases reported so far [1,2]. Case presentation A 65 year old male patient, diagnosed with hypothyroidism one year ago, was transferred to our unit in a state of drowsiness and confusion. On admission to our unit (2 weeks after the initial presentation and while on thyroxine replacement), his TSH level had dropped to 29.9 mIU/μl, and the FT4 level was 0.61 ng/dl (0.89-1.76) - he was still severely hypothyroid. His serum creatinine had progressively risen from 122 μmol/l to 629 μmol/l with a concomitant drop in urine output (less than 30 ml per hour). Serum electrolytes were normal for several days prior to death
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