SevereHypothyroidismmasqueradingasRenalimpairment.docVIP

Severe Hypothyroidism masquerading as Renal impairment Chia-Shan Liu1, Tsai-Kun Wu1, Ying-Lan Yu1, Shiaw-Wen Chien1, Mei-An Tsai Pai1, Yuan-Chuan Kuo1,Cheng-Lin Tsai2, Paik-Seong Lim1 1Division of Nephrology, 2Divison of Endocrinology and Metabolism, Department of Internal Medicine, Tungs’ Taichung MetroHartor Hospital Running title: Severe PTH masquerading as Renal impairment in two Young men Address reprint request to: Dr. Paik-Seong Lim, Division of Nephrology, Department of Internal Medicine, Tungs’ Taichung MetroHartor Hospital, No. 699, Sec.1, Chungchi Rd., Wuchi, Taichung, 43503, Taiwan-R.O.C. Tel: 04ext 53280 Fax: 04E-mail:t2355@.tw Abstract: Although hypothyroidism is highly prevalent in patients with chronic kidney disease, it is an often underrecognized and undertreated cause of renal impairment. We described a 33 year-old young man who presented with acute deterioration of renal function. He described a 2 weeks history of sudden onset peri-orbital, facial and generalised leg swelling. Thyroid function tests showed a free thyroxine (FT4) concentration of 9 pmol/L and a thyroid stimulating hormone (TSH) concentration of 237 uU/ml, consistent with severe hypothyroidism. Treatment for hypothyroid status resulted in a significant and sustained reduction of his serum creatinine level. Deficiency of thyroid hormones had been shown to reduce GFR and its pathophysiology is multifactorial. Since in most cases of hypothyroidism the clinical manifestations may be subtle or absent, we recommended that thyroid status should be assessed in patients with renal dysfunction. Key Words: hypothyroidism , renal insufficiency, thyroid stimulatory hormone 甲狀腺機能低下症偽裝成腎臟功能不全 劉家珊1、吳再坤1、尤英覽1、簡孝文1、白美安1、郭元銓1、蔡政麟2、林柏松1 童綜合醫療社團法人童綜合醫院 1腎臟內科 2內分泌暨新陳代謝科 甲狀腺機能低下時肌酸酐輕微上升的情形，較常發生在年紀大的女性而罕見於年輕男性，1,2我們提出一個腎功能急速惡化的三十三歲年輕男性案例，他的臨床症狀有臉部腫漲、短期內體重增加、肌肉無力、下肢水腫，沒有劇烈運動或使用抗甲狀腺藥物，他起初的血清肌酸酐為1.6 mg/dL (141.4μmol/L)，肌酸酐清除率為 1.32 mL/s (79.2 mL/mi