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Hypothyroidism and reversible kidney dysfunction: an essential relationship to recognize.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	El Ters, Mireille Patel, Sandeep M. Norby, Suzanne M.
Description	Author Affiliation: El Ters M ( Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.); Patel SM ( The Heart and Vascular Institute, University of Pittsburgh, Pennsylvania.); Norby SM ( Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.)
Abstract	OBJECTIVE: To report 3 cases of reversible hypothyroidism-induced kidney dysfunction and review the interaction between these commonly encountered, yet seemingly disparate, conditions. METHODS: We describe the clinical course and laboratory and physical findings of 3 patients who presented with kidney dysfunction that improved after initiating thyroid hormone replacement therapy. We also review similar cases in the literature and discuss the pathophysiologic mechanisms. RESULTS: A 68-year-old male presented with classical signs and symptoms of hypothyroidism, including fatigue, confusion, and gait imbalance. Physical exam showed bradycardia, thyromegaly, slow mentation, and cracked, thin skin; he was found to have decreased kidney function. Second, a 42-year-old previously healthy female presented with bilateral hand swelling and elevated serum creatinine with an otherwise unremarkable physical exam. The third patient was a 72-year-old male with advanced heart failure on amiodarone and stage 3 chronic kidney disease who presented with fatigue, acute kidney injury, and lower extremity edema. In all cases, serum creatinine and thyroid-stimulating hormone (TSH) were elevated at presentation (1.4-3.0 mg/dL and 94.1-184 mIU/L respectively), and free thyroxine (T4) was low (undetectable-0.4 ng/dL). The initiation or increased dose of levothyroxine normalized serum creatinine to baseline within 2 to 10 months. CONCLUSION: Hypothyroidism and kidney dysfunction are both commonly encountered clinical entities, but the interplay between the thyroid gland and kidneys may be infrequently recalled, causing the reversible relationship between these 2 disorders to be missed.
File Format	HTM / HTML
ISSN	1530891X
Issue Number	5
Volume Number	20
e-ISSN	19342403
Journal	Endocrine Practice
Language	English
Publisher	American Association of Clinical Endocrinologists
Publisher Date	2014-05-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Endocrinology Hypothyroidism Complications Kidney Diseases Etiology Adult Aged Female Glomerular Filtration Rate Humans Male Renal Insufficiency, Chronic Case Reports Journal Article Review
Content Type	Text
Resource Type	Case study Article
Subject	Endocrinology, Diabetes and Metabolism Endocrinology

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