Neves Precil Diego Miranda de Menezes, Bridi Ramaiane Aparecida, Balbi André Luis, Ponce Daniela
Department of Internal Medicine, University São Paulo State-UNESP, Botucatu, Sao Paulo, Brazil.
BMJ Case Rep. 2013 Aug 9;2013:bcr2013200585. doi: 10.1136/bcr-2013-200585.
Association between severe hypothyroidism and acute kidney injury (AKI) is rare. A 40-year-old woman presented with 15 days history of generalised muscle pain, weakness, weight gain and oedema.
hypertension and hypothyroidism.
dry skin, peripheral/periorbital oedema, slow thought and speaking, thyroid increased. Laboratory examinations: high levels of creatine kinase , creatinine, uric acid and lactate dehydrogenase. Free T4 was very low (<0.3 ng/dL) and thyroid-stimulating hormone was high (21.7 µIU/mL). Urinalysis showed haem pigment without haematuria. We performed the diagnosis of AKI secondary to hypothyroidism-induced rhabdomyolysis. Intravenous fluids were started, urinary alkalisation and increased l-thyroxine dose replacement. On the day after admission, forced diuresis with furosemide was introduced leading to a progressive improvement of symptoms. Although hypothyroidism and AKI is unusual, it should be suspected in patients presenting decrease of renal function and high creatine kinase in the absence of other causes of rhabdomyolysis.
严重甲状腺功能减退与急性肾损伤（AKI）之间的关联罕见。一名40岁女性，有15天全身肌肉疼痛、无力、体重增加和水肿病史。
高血压和甲状腺功能减退。
皮肤干燥、外周/眶周水肿、思维和言语迟缓、甲状腺肿大。实验室检查：肌酸激酶、肌酐、尿酸和乳酸脱氢酶水平升高。游离甲状腺素极低（<0.3 ng/dL），促甲状腺激素升高（21.7 μIU/mL）。尿液分析显示有血红蛋白但无血尿。我们诊断为继发于甲状腺功能减退所致横纹肌溶解的急性肾损伤。开始静脉补液、尿液碱化并增加左甲状腺素剂量替代治疗。入院次日，加用呋塞米进行强制利尿，症状逐渐改善。虽然甲状腺功能减退和急性肾损伤并不常见，但在无其他横纹肌溶解病因的情况下，出现肾功能减退和肌酸激酶升高的患者应怀疑此病。
