The Turkish Journal of Pediatrics
2011 , Vol 53 , Num 5
Severe Rhabdomyolysis and Acute Renal Failure in an Adolescent with Hypothyroidism
Departments of 1Pediatric Nephrology, 2Pathology, and 3Pediatric Endocrinology, Akdeniz University Faculty of Medicine,
Antalya, Turkey
Hypothyroidism has been reported rarely as the cause of rhabdomyolysis
in adults and children. We present here a non-compliant adolescent with a
diagnosis of hypothyroidism who developed rhabdomyolysis and acute renal
failure with no additional predisposing factor. A 13-year-old girl with a
previous history of hypothyroidism due to thyroid hypoplasia presented with
generalized myalgia, malaise, vomiting, and oliguria lasting for three days.
Neurological examination revealed bilateral marked weakness and tenderness
of muscles of both lower and upper extremities. Urine had bloody appearance
and urine analysis showed blood reaction with dipstick test, but there were
no erythrocytes on microscopic examination. Serum creatine phosphokinase
and myoglobin levels were elevated. Thyroid stimulating hormone (TSH)
levels were high, and free thyroxine (T4) and triiodothyronine (T3) levels
were low, compatible with uncontrolled hypothyroidism. Renal function
tests showed acute renal failure. Other causes of rhabdomyolysis such as
muscular trauma, drugs, toxins, infections, vigorous exercise, and electrolyte
abnormalities were excluded. Hemodialysis was administered for 24 sessions.
After L-thyroxine therapy, thyroid function tests normalized, muscle strength
improved, serum muscle enzyme levels returned to normal levels, and renal
function tests recovered. One must be aware that rhabdomyolysis may develop
in a non-compliant patient with hypothyroidism.
Keywords :
rhabdomyolysis, hypothyroidism, acute renal failure.