Hyperkalemia with mild azotemia in a post-thyroidectomized patient: A case report and literature review

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Thana Thongsricome
Duangporn Werawatganon
Pasakorn Watanatada


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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Thongsricome, T., Werawatganon, D., & Watanatada, P. (2022). Hyperkalemia with mild azotemia in a post-thyroidectomized patient: A case report and literature review. Journal of the Nephrology Society of Thailand, 28(3), 65–72. Retrieved from https://he01.tci-thaijo.org/index.php/JNST/article/view/259155
Case Report


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