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Background: Apart from hyponatremia, azotemia has been found to be associated with hypothyroidism by inconclusive mechanism, possibly falsely elevated creatinine, decreased tubular secretion of creatinine, reversible pre-renal kidney injury from decreased cardiac output, renal vasoconstriction, increased systemic vascular resistance, or irreversible tubulo-interstitial injury which can lead to chronic kidney disease. Hyperkalemia is also an infrequent manifestation in some hypothyroid patients with unproven mechanism since previous case reports have not explored urinary electrolyte analysis.
Case report: We report a patient with mild azotemia and hyperkalemia in profound hypothyroid state while taking low-iodine diet. Urinary electrolyte analysis reveals no impairment in potassium excretion. Moreover, the abnormalities were normalized after thyroid hormone supplementation. Hence, we propose a possible mechanism of decreased intracellular potassium shift as a cause of hyperkalemia in hypothyroid patient, which may be aggravated by high potassium content in low-iodine diet. We also review other renal manifestations in hypothyroidism including proteinuria, hyperuricemia, and renal acidification defect.
Conclusions: Our case report emphasizes the importance of monitoring renal function and serum electrolytes in profound or high-risk hypothyroid patients, and awareness of thyroid dysfunction in patients with unexplained hyperkalemia or azotemia.
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Mariani LH, Berns JS. The renal manifestations of thyroid disease. J Am Soc Nephrol 2012;23:22-6.
Iglesias P, Bajo MA, Selgas R, Diez JJ. Thyroid dysfunction and kidney disease: An update. Rev Endocr Metab Disord 2017;18:131-44.
Rhee CM. The interaction between thyroid and kidney disease: an overview of the evidence. Curr Opin Endocrinol Diabetes Obes 2016;23:407-15.
Weerakkody RM, Lokuliyana PN. Severe hypothyroidism presenting as reversible proteinuria: two case reports. J Med Case Rep 2019;13:270.
Chandra A, Rao N, Malhotra K. Severe hypothyroidismassociated acute renal failure – A case series from North India and review of literature. 6. Thyroid Research and Practice 2019;16. Huang CW, Li BH, Reynolds K, Jacobsen SJ, Rhee CM, Sim JJ. Association between hypothyroidism and
chronic kidney disease observed among an adult population 55 years and older. Medicine (Baltimore) 2020;99:e19569.
Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet 2017;390:1550-62.
Rehman SU, Cope DW, Senseney AD, Brzezinski W. Thyroid disorders in elderly patients. South Med J 2005;98:543-9.
Javed Z, Sathyapalan T. Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefits. Ther Adv Endocrinol Metab 2016;7:12-23.
Saini V, Yadav A, Arora MK, Arora S, Singh R, Bhattacharjee J. Correlation of creatinine with TSH levels in overt hypothyroidism - a requirement for monitoring of renal function in hypothyroid patients? Clin Biochem 2012;45:212-4.
Zhang Y, Wang Y, Tao XJ, Li Q, Li FF, Lee KO, et al. Relationship between Thyroid Function and Kidney Function in Patients with Type 2 Diabetes. Int J Endocrinol 2018;2018:1871530.
Kim SH, Min HK, Lee SW. Relationship between Thyroid and Kidney Function: Analysis from the Korea National Health and Nutrition Examination Survey Between 2013 and 2015. Kidney Blood Press Res 2020;45:442-54.
Shin DH, Lee MJ, Lee HS, Oh HJ, Ko KI, Kim CH, et al. Thyroid hormone replacement therapy attenuates the decline of renal function in chronic kidney disease patients with subclinical hypothyroidism. Thyroid 2013;23:654-61.
Lafayette RA, Costa ME, King AJ. Increased serum creatinine in the absence of renal failure in profound hypothyroidism. Am J Med 1994;96:298-9.
McDonough AA, Brown TA, Horowitz B, Chiu R, Schlotterbeck J, Bowen J, et al. Thyroid hormone coordinately regulates Na+-K+-ATPase alpha- and beta-subunit mRNA levels in kidney. Am J Physiol 1988;254:C323-9.
Silva GC, Carneiro JB, Tardelli CC, Risso M, Ventura Mde M. Kidney failure in the elderly due to hypothyroidism: a case report. Sao Paulo Med J 2008;126:291-3.
Liakopoulos V, Dovas S, Simopoulou T, Zarogiannis S, Giannopoulou M, Kourti P, et al. Acute renal failure: a rare presentation of hypothyroidism. Ren Fail 2009;31:323-6.
Abdella A, Ekoon B, Modawe G. The impact of thyroid dysfunction on renal function tests. Saudi Journal of Kidney Diseases and Transplantation 2013;24:132-4.
Mahjoub S, Ben Dhia N, Achour A, Zebidi A, Frih A, Elmay M. [Primary hypothyroidism and glomerular involvement]. Ann Endocrinol (Paris) 1991;52:289-92.
Jordan SC, Johnston WH, Bergstein JM. Immune complex glomerulonephritis mediated by thyroid antigens. Arch Pathol Lab Med 1978;102:530-3.
Shima Y, Nakanishi K, Togawa H, Obana M, Sako M, Miyawaki M, et al. Membranous nephropathy associated with thyroid-peroxidase antigen. Pediatr Nephrol 2009;24:605-8.
Giordano N, Santacroce C, Mattii G, Geraci S, Amendola A, Gennari C. Hyperuricemia and gout in thyroid endocrine disorders. Clin Exp Rheumatol 2001;19:661-5.
Oster JR, Michael UF, Perez GO, Sonneborn RE, Vaamonde CA. Renal acidification in hypothyroid man. Clin Nephrol 1976;6:398-403.
Horie I, Ando T, Imaizumi M, Usa T, Kawakami A. Hyperkalemia develops in some thyroidectomized patients undergoing thyroid hormone withdrawal in preparation for radioactive iodine ablation for thyroid carcinoma. Endocr Pract 2015;21:488-94.
Schaafsma IA, van Emst MG, Kooistra HS, Verkleij CB, Peeters ME, Boer P, et al. Exercise-induced hyperkalemia in hypothyroid dogs. Domest Anim Endocrinol 2002;22:113-25.
Kjeldsen K, Nørgaard A, Gøtzsche CO, Thomassen A, Clausen T. Effect of thyroid function on number of Na-K pumps in human skeletal muscle. Lancet 1984;2:8-10.
Kubota K, Ingbar SH. Influences of thyroid status and sympathoadrenal system on extrarenal potassium disposal. Am J Physiol 1990;258:E428-35.