Weerakkody Ranga Migara, Lokuliyana Pushpa Nandani
Department of Nephrology, Teaching Hospital, Jaffna, Sri Lanka.
Department of Pain Medicine, National Hospital of Sri Lanka, Regent Street, Colombo, 10, Sri Lanka.
J Med Case Rep. 2019 Aug 28;13(1):270. doi: 10.1186/s13256-019-2216-3.
Hypothyroidism is a common medical disorder which results in many metabolic effects, such as dyslipidemia, hypertension, accelerated atherosclerosis, and coronary artery disease. Hypothyroidism affects the renal physiology by affecting the renal blood flow, vascular resistance, and sodium handling. Recent studies have shown hypothyroidism is associated with decreased estimated renal function and proteinuria. Rhabdomyolysis and acute renal insufficiency have also been described in association with hypothyroidism. The severity of the proteinuria was directly proportional to thyroid-stimulating hormone levels. Currently, there is a lack of evidence on the reversibility of proteinuria in hypothyroidism. This is the first report in the literature, to the best of our knowledge, demonstrating the reversibility of proteinuria associated with hypothyroidism, with treatment.
Here we describe two cases, a 72-year-old Sinhalese man and a 47-year-old Tamil woman, from Sri Lanka, presenting with overt hypothyroidism; they were found to have elevated creatinine, proteinuria, and elevated creatinine kinase levels. Due to lack of active sediment in urine analysis, these patients were observed after the initiation of thyroxine therapy. They were investigated in the adult-onset proteinuria pathway, excluding common reasons for proteinuria. Both patients responded to treatment: their serum creatinine, creatinine kinase, and urine protein levels reverted to physiological levels within 6 months of treatment with thyroxine, and with normalization of thyroid-stimulating hormone.
Hypothyroidism can present as renal insufficiency, proteinuria, and can mimic rhabdomyolysis. Prompt initiation of thyroxine treatment and control of thyroid-stimulating hormone levels could reverse these changes.
甲状腺功能减退是一种常见的医学病症，会导致多种代谢影响，如血脂异常、高血压、动脉粥样硬化加速和冠状动脉疾病。甲状腺功能减退通过影响肾血流量、血管阻力和钠处理来影响肾脏生理功能。最近的研究表明，甲状腺功能减退与估计的肾功能下降和蛋白尿有关。横纹肌溶解症和急性肾功能不全也被描述为与甲状腺功能减退有关。蛋白尿的严重程度与促甲状腺激素水平直接相关。目前缺乏关于甲状腺功能减退中蛋白尿可逆性的证据。据我们所知，这是文献中的首例报告，证明了与甲状腺功能减退相关的蛋白尿经治疗后具有可逆性。
我们在此描述两例来自斯里兰卡的病例，一名72岁的僧伽罗男性和一名47岁的泰米尔女性，均表现为明显的甲状腺功能减退；他们被发现肌酐升高、蛋白尿和肌酸激酶水平升高。由于尿液分析中没有活动性沉渣，在开始甲状腺素治疗后对这些患者进行了观察。他们按照成人起病蛋白尿路径进行了检查，排除了蛋白尿的常见原因。两名患者均对治疗有反应：在使用甲状腺素治疗6个月内，随着促甲状腺激素水平恢复正常，他们的血清肌酐、肌酸激酶和尿蛋白水平恢复到生理水平。
甲状腺功能减退可表现为肾功能不全、蛋白尿，并可类似横纹肌溶解症。及时开始甲状腺素治疗并控制促甲状腺激素水平可逆转这些变化。
