Espiritu Rachel P, Stan Marius N
Division of Endocrinology, Diabetes, Nutrition, Metabolism, Mayo Clinic, Rochester, MN 55901, USA.
Endocr Pract. 2008 Nov;14(8):1023-6. doi: 10.4158/EP.14.8.1023.
To report a case of rhabdomyolysis presenting with severe hyperkalemia after withdrawal of thyroid hormone in a patient with differentiated thyroid cancer.
We describe the clinical and laboratory findings of the study patient and review the relevant literature.
A 54-year-old man with progressive generalized weakness and myalgias presented with acute renal failure and hyperkalemia. He had undergone total thyroidectomy for papillary thyroid cancer 6 weeks earlier and had discontinued thyroid hormone 2 weeks before his current presentation in preparation for thyroid remnant ablation. He had a history of multiple colon and small-bowel resections for familial adenomatous polyposis and desmoid tumor. He was severely dehydrated on examination. Laboratory tests results included the following values: creatine phosphokinase, 5265 U/L (reference range, 52-336 U/L); creatinine, 2.1 mg/dL; potassium, >8.0 mEq/L; and thyrotropin, 92.2 mIU/L. His condition was diagnosed as rhabdomyolysis, and his fluid deficit and hyperkalemia were treated aggressively. Cardiac status remained stable, and both acute renal failure and hyperkalemia improved. He then received remnant ablation, and thyroid hormone was restarted. His muscle complaints resolved over the following 3 months.
Hypothyroidism-induced rhabdomyolysis can occur during thyroid hormone withdrawal and can present with life-threatening hyperkalemia. Patients under-going thyroid hormone withdrawal should be assessed for risk of rhabdomyolysis, and preventive strategies should be implemented, including prevention of dehydration. The use of recombinant thyrotropin, rather than thyroid hormone withdrawal, should be considered in those who are at high risk for such complications.
报告1例分化型甲状腺癌患者在停用甲状腺激素后出现横纹肌溶解并伴有严重高钾血症的病例。
我们描述了该研究患者的临床和实验室检查结果，并回顾了相关文献。
一名54岁男性，出现进行性全身无力和肌痛，伴有急性肾衰竭和高钾血症。他在6周前因乳头状甲状腺癌接受了全甲状腺切除术，并在本次就诊前2周停用了甲状腺激素，为甲状腺残余消融做准备。他有因家族性腺瘤性息肉病和硬纤维瘤进行多次结肠和小肠切除术的病史。检查时发现他严重脱水。实验室检查结果包括：肌酸磷酸激酶5265 U/L（参考范围52 - 336 U/L）；肌酐2.1 mg/dL；钾>8.0 mEq/L；促甲状腺激素92.2 mIU/L。他的病情被诊断为横纹肌溶解，对其液体缺失和高钾血症进行了积极治疗。心脏状况保持稳定，急性肾衰竭和高钾血症均有所改善。随后他接受了残余消融，并重新开始使用甲状腺激素。在接下来的3个月里，他的肌肉症状消失。
甲状腺功能减退引起的横纹肌溶解可在停用甲状腺激素期间发生，并可伴有危及生命的高钾血症。对正在停用甲状腺激素的患者应评估横纹肌溶解的风险，并应实施预防策略，包括预防脱水。对于发生此类并发症风险高的患者，应考虑使用重组促甲状腺激素而非停用甲状腺激素。
