Kidney failure in the elderly due to hypothyroidism: a case report

CONTEXT: Hypothyroidism is more prevalent in the elderly and its symptoms can be confused with other changes due to aging. Doctors caring for the elderly need to be attentive to this diagnostic possibility. This case report case is notable not only because it presents a rare complication of hypothyroidism (kidney failure), but also because patients with chronic kidney failure of any etiology may suffer increased renal dysfunction as a result. CASE REPORT: This was a 66-year-old male outpatient with a history of generalized edema over the preceding eight years, with periods of worsening, that was intractable to treatment with diuretics. Physical examination revealed bradycardia (heart rate: 52 bpm), pallor, dry and infiltrated skin, macroglossia, edema in the lower limbs and a palpable thyroid with hard consistency. Laboratory tests showed: creatinine 3.9 mg/dl; urea 95 mg/dl; potassium 6.0 mEq/l; thyroid-stimulating hormone > 100 mUI/ml; triiodothyronine 0.01 ng/dl; free thyroxin 0.01 ng/dl; antithyroglobulin 31 IU/ml (normal values: < 40 IU/ml); antithyroperoxidase 85 IU/ml (normal values: < 15 IU/ml); creatinine clearance 30 ml/min/1.73 m²; and proteinuria 122 mg/24 h. After five months of treatment with thyroxin (100 mcg/day), the patient returned without any symptoms and presented the following test results: urea 48 mg/dl; creatinine 1.4 mg/dl; creatinine clearance 67 ml/min/1.73 m²; potassium 4.2 mEq/l; thyroid-stimulating hormone: 20.85 mUI/ml; free thyroxin: 0.71 ng/dl. Hypothyroidism alone can cause renal impairment or worsen renal function in preexisting illnesses. Its treatment can stabilize the clinical condition, or possibly improve it.

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Inferior epigastric artery pseudoaneurysm following abdominal paracentesis in a patient with chronic kidney failure: a case report and review of literature

10.22541/au.163685233.35833815/v1 ◽

2021 ◽

Author(s):

Behnam Kian ◽

Arash Teimouri

Keyword(s):

Case Report ◽

Large Volume ◽

Kidney Failure ◽

Rare Complication ◽

Chronic Kidney Failure ◽

Review Of Literature ◽

Inferior Epigastric Artery ◽

Artery Pseudoaneurysm ◽

Epigastric Artery ◽

Abdominal Paracentesis

Inferior epigastric artery pseudoaneurysm is a rare complication following abdominal wall procedures near the artery. This is a case of Inferior epigastric artery pseudoaneurysm after therapeutic paracentesis for large volume ascites caused by chronic kidney failure. The patient was operated on, and the artery was ligated.

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Hipotiroidismo Subclínico no Idoso

Acta Médica Portuguesa ◽

10.20344/amp.10991 ◽

2018 ◽

Vol 31 (12) ◽

pp. 766

Author(s):

Sofia Macedo Silva ◽

Alexandra Carvalho ◽

Maria Lopes- Pereira ◽

Vera Fernandes

Keyword(s):

Subclinical Hypothyroidism ◽

The Elderly ◽

Thyroid Stimulating Hormone ◽

Reference Level ◽

Thyroid Antibodies ◽

Electronic Database Search ◽

Definition Of ◽

A Minor ◽

In The Beginning ◽

Stimulating Hormone

Introduction: Subclinical hypothyroidism, defined as an increase of thyroid stimulating hormone levels with normal levels of thyroid hormones, could have a multiorgan impact. There seem to be differences in the elderly (over 65 years of age) which indicate that there should be a different approach in terms of diagnosis and the treatment.Material and Methods: Electronic database search and narrative bibliographical review.Results: Different case studies showing the multiorgan consequences of subclinical hypothyroidism suggest that, in the elderly, there is a minor impact or even a lack of repercussion, especially in those over 80 - 85 years old. Additionally, there is evidence indicating that the levels of thyroid stimulating hormone rise with the age of the patient. The standard treatment, in the beginning, is a low dose of levothyroxine when the levels of thyroid stimulating hormone are over 10.0 mIU/L, when there are noticeable symptoms or positive anti-thyroid antibodies. However, the treatment is not consensual when the levels of thyroid stimulating hormone are between 4.5 and 10.0 mIU/L, in such a way that the TRUST study concluded that no benefits have outcome from treating these patients. Discussion: The non-definition of the reference range and the age gap are the key factors that contribute the most to biased results. However, there is consensus regarding non-treatment of mild thyroid dysfunctions (4.5 - 7.0 mIU/L) in the elderly, particularly above 80 years of age. Nevertheless, for positive anti-thyroid antibodies, suggestive ultrasound changes or iatrogenic side effects, the reference level should be 4.5 mIU/L. Conclusion: The general impact of subclinical hypothyroidism is different in elderly people, meaning that an individualized therapeutic approach and long-term monitoring is the appropriate strategy.

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