Hypothyroidism-associated rhabdomyolysis: A new case report and review of the reported cases

Abstract

Background: Hypothyroidism alone or in combination with other factors has the risk of triggering rhabdomyolysis. In this article, we aim to describe hypothyroidism-associated rhabdomyolysis and its outcomes. Methods: We reported a new case of hypothyroidism-associated rhabdomyolysis and reviewed similar reported cases from the literature for in-depth knowledge. Results: Eighty-one cases, including the one reported in this article, met the inclusion criteria for this review. The mean age of the patients was 45.6 ± 15.8 years. Out of these, 57 (70.4%) patients were males and 24 (29.6%) were females. The precipitating factor was absent in 45 (55.6%) cases. A total of 8 (9.9%) cases had chronic renal failure at time of presentation, while 25 (30.9%) had hypertension, 11 (13.6%) had diabetes mellitus, and 32 (39.5%) had dyslipidemia. The median creatine kinase (CK) level was 5885 U/L (Interquartile range: 3280.5–11550.5 U/L). Electromyography was performed in 12 patients with 10 (12.3%) cases showing myopathic changes including polyphasic potential and fiber necrosis. Muscle biopsy was performed in 7 (8.4%) cases, with Type II fiber atrophy observed in 4 (4.9%) biopsies. Sixty-two cases developed acute kidney injury, of which 14 (17.3%) required hemodialysis. All patients were treated with levothyroxine and most patients (67, 82.7%) were treated by hydration. All the reported patients made good recovery. A statistically nonsignificant correlation was found between CK and thyroid-stimulating hormone (r = 0.218; P = 0.052). Conclusions: Rhabdomyolysis is a recognized complication of hypothyroidism even in the absence of additional risk factors. Clinicians should be aware of the impact of rhabdomyolysis and hypothyroidism on renal function and promptly initiate hormone replacement therapy and vigorous hydration to preserve the renal function.