Rhabdomyolysis as a Rare Clinical Manifestation of Hypothyroidism: About Two Clinical Cases
Hypothyroidism is associated with a wide spectrum of clinical manifestations, which vary in relation to the magnitude of the thyroid hormone deficiency and acuteness of its development.
Muscle involvement is common, although rhabdomyolysis is relatively rare.
In this article we will present two clinical cases with newly diagnosed hypothyroidism, in which rhabdomyolysis was an important clue to diagnosis. The first patient, obese (with recent onset of physical activity), was admitted due to hypertensive crisis, associated with fatigue. Laboratory tests showed elevation of muscle enzymes with acute renal injury and dyslipidemia. Evaluation of secondary
hypertension in a patient with persistent high muscle enzymes led to the diagnosis of hypothyroidism. The second patient, with previous diagnosis of dyslipidemia (under statins), was admitted due to bilateral and symmetric facial oedema, with extension to upper and lower limbs (predominantly distal). He also complained of myalgia, fatigue, weight gain, hoarseness and snoring. Laboratory tests showed rhabdomyolysis with acute renal injury. Hypothyroidism was placed as a possible diagnosis, which was later confirmed in laboratory evaluation. Both patients were treated with levothyroxine, with subsequent normalization of muscle enzymes and progressive improvement of serum creatinine.
The presentation of these two cases shows the diversity of signs and symptoms present in hypothyroidism. Besides, in case of myalgia and disabling fatigue, thyroid function assessment must be done, after exclusion of other etiologies.
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