Abstract
BackgroundHashimoto’s thyroiditis is typically diagnosed incidentally from elevated TSH or after evaluation of suggestive symptoms, including weight gain and fatigue. Rarely, patients present with an initial hyperthyroid state, Hashitoxicosis, that lasts weeks to months. Through a review of the current literature, it became apparent that this case is unique in several ways: the patient’s age, lack of comorbid conditions, the unique presentation of her thyroid disease, as well as the development of acute kidney injury while hospitalized.Case PresentationHere we present the case of a 26-year-old female who was referred to the Endocrinology office in July 2019 with symptoms of hyperthyroidism. She has a positive family history of Graves’ disease (GD) in her mother and thyroid malignancy in her maternal aunt. On her initial visit, TSH was suppressed, free thyroid hormones were increased, and both TPO and TSI antibodies were elevated. It was determined that this was likely a presentation of GD, and the patient was started on methimazole. She was instructed to follow-up every four weeks for monitoring of symptoms and labs. Three months following the initial visit, the patient failed to follow-up in office. During this time, she was seen by her primary care physician, diagnosed with hyperlipidemia, and started on statin therapy. One month later, on a subsequent follow-up with endocrinology, the patient complained of new onset back pain, muscle cramps, weight gain, and cold intolerance. She was sent to the emergency department for work-up. Evaluation revealed rhabdomyolysis in the setting of severe hypothyroidism, complicated by acute kidney injury. Her final diagnosis was found to be Hashitoxicosis with subsequent hypothyroidism.ConclusionsHyper- and hypothyroidism are two extremes on the spectrum of autoimmune thyroid disease, and the presentation can vary from patient-to-patient. Rarely, severe hypothyroidism can present with rhabdomyolysis with increased risk in patients on statin therapy. Thus, it is important to ensure patients are clinically and biochemically euthyroid prior to initiation of statin therapy. This case emphasizes the need for communication among physicians and the importance of patient adherence to treatment plans.
Rhabdomyolysis and Acute Kidney Injury Associated with Hypothyroidism and Statin Therapy
