Essaddam Leïla, Ben Mansour Asma, Missaoui Nada, Guedri Rahma, Mattoussi Nadia, Fitouri Zohra, Ben Becher Saayda
1Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007 Tunis, Tunisia.
Department of Pediatrics, Emergency and Outpatient Clinics (PUC), Children Hospital Béchir Hamza de Tunis, Bab Saadoun, Jebbari, 1007 Tunis, Tunisia.
J Diabetes Metab Disord. 2019 Aug 14;18(2):733-738. doi: 10.1007/s40200-019-00430-1. eCollection 2019 Dec.
Hypothyroidism with impairment of renal function and raised creatinine phosphokinase (CPK) is described in adults and children with acquired hypothyroidism, but not in congenital hypothyroidism.
A male infant born at term weighing 3390 g was seen aged 2 months with prolonged jaundice. Examination showed somnolence, umbilical hernia, enlarged fontanelles and lower limb edema; length 55 cm (-1.5 SD), weight 5.4 kg (-0.13 SD). Biochemistry showed fT4 < 1 pmol/L, TSH = 1044.36 μUI/mL, creatinine 77 μmol/L(normal <35 μmol/L), estimated glomerular filtration rate (GFR) 26 ml/min/1.73 m, CPK 3952.5 IU/L (normal<400 IU/L). Ultrasound showed no thyroid tissue in the neck. In view of the renal impairment, peritoneal dialysis was initially contemplated but postponed and the child received levothyroxine 10 μg/kg/day. Two months later thyroid function tests, CPK and renal function had all normalized with creatinine 19 μmol/L and GFR 116 ml/min/1.73m.
Reversible renal impairment is attributable to severe congenital hypothyroidism causing decreased myocardial contractility and cardiac output and to a direct effect on the kidneys. Thyroid function should be checked in infants with renal impairment of unknown cause. Cautious fluid management is indicated in hypothyroid infants. Hypothyroidism may also be associated with elevated serum CPK levels but resolves with thyroxin therapy.
成人和儿童获得性甲状腺功能减退症患者中存在甲状腺功能减退伴肾功能损害及肌酸磷酸激酶（CPK）升高的情况，但先天性甲状腺功能减退症患者中未见此类报道。
一名足月出生、体重3390克的男婴，2个月大时因黄疸持续不退前来就诊。检查发现患儿嗜睡、脐疝、囟门增大及下肢水肿；身长55厘米（-1.5标准差），体重5.4千克（-0.13标准差）。生化检查显示游离甲状腺素（fT4）<1皮摩尔/升，促甲状腺激素（TSH）=1044.36微国际单位/毫升，肌酐77微摩尔/升（正常<35微摩尔/升），估计肾小球滤过率（GFR）26毫升/分钟/1.73平方米，CPK 3952.5国际单位/升（正常<400国际单位/升）。超声检查显示颈部无甲状腺组织。鉴于肾功能损害，最初考虑进行腹膜透析，但推迟了，患儿接受左甲状腺素10微克/千克/天的治疗。两个月后，甲状腺功能检查、CPK和肾功能均恢复正常，肌酐为19微摩尔/升，GFR为116毫升/分钟/1.73平方米。
可逆性肾功能损害归因于严重的先天性甲状腺功能减退症导致心肌收缩力和心输出量降低以及对肾脏的直接影响。对于病因不明的肾功能损害婴儿，应检查甲状腺功能。甲状腺功能减退的婴儿需要谨慎进行液体管理。甲状腺功能减退症也可能与血清CPK水平升高有关，但甲状腺素治疗后可恢复正常。
