Exacerbation of underlying hypothyroidism caused by proteinuria and induction of urinary thyroxine loss: case report and subsequent investigation
| Autor: | Edward Randell, John Shik, Vikram Chandurkar |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
Adult
medicine.medical_specialty Exacerbation Endocrinology Diabetes and Metabolism Urinary system Nephrosis Levothyroxine Urology Urine Kidney Weight Gain Excretion Endocrinology Hypothyroidism Internal medicine medicine Humans Proteinuria business.industry Nephrosis Lipoid General Medicine Continuity of Patient Care medicine.disease Thyroxine Female medicine.symptom business Nephrotic syndrome medicine.drug |
| Zdroj: | Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 14(1) |
| ISSN: | 1934-2403 |
| Popis: | Objective To describe a patient with excess urinary thyroxine (T4) excretion and worsening of preexisting hypothyroidism in the setting of nephrotic syndrome and to determine whether excess urinary T4 excretion is present in other patients with proteinuria. Methods We present data regarding the patient's initial presentation, diagnostic studies, and course of her illness. We suspected urinary T4 loss to be the cause of her presentation and analyzed her urine sample for total T4. We also analyzed differences in urinary T4 excretion in 22 patients with proteinuria and 16 control patients without proteinuria. Relevant medical literature is reviewed. Results A 44-year-old woman presented with a 3-month history of increasing fluid retention, weight gain, and fatigue. She had long-standing hypothyroidism on a stable levothyroxine dosage, 125 mcg/d. She had gained 27 kg and had developed significant edema. She had a grossly elevated thyroid-stimulating hormone level of 91 mIU/L. Her condition worsened, and a urinary protein measurement was 14.06 g/24 h—diagnostic of nephrotic syndrome. The levothyroxine dosage was increased to 225 mcg/d. Urinary total T4 concentration in a 24-hour sample was 59.0 μg/L (83.1 μg/24 h), indicating that a substantial fraction of her orally ingested T4 was lost in urine. Urinary total T4 excretion was significantly higher in patients with proteinuria (mean ± standard deviation, 18.0 ± 18.2 μg/L) vs control patients without proteinuria (mean, 3.8 ± 1.8 μg/L) (P = .0014). Conclusion In the patient described, urinary T4 loss due to proteinuria and nephrotic syndrome resulted in a severe exacerbation of underlying hypothyroidism. (Endocr Pract. 2008;14:97-103) |
| Databáze: | OpenAIRE |
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