Salt-losing nephropathy in hypothyroidism.
A 35-year-old man presented with recurrent lower extremity weakness associated with polyuria later progressing to generalised weakness with difficulty in breathing. The patient was hypotensive and dry, with normal thyroid and chest examination, weak lower extremity and carpopedal spasm. Workup revealed hypokalaemia, hyponatraemia, hypocalcaemia, hypomagnesaemia, hypochloraemia and hypophosphataemia. Arterial blood gas showed respiratory alkalosis with good oxygenation. Twenty-four-hour urine collection showed normal volume with electrolyte wasting. Thyroid function test revealed overt hypothyroidism with negative antithyroid peroxidase. The patient was well after treatment with levothyroxine, volume and electrolyte replacement and was discharged. Thyroid hormones are related to the expression of the Na-K-ATPase, Na-Pi cotransporter, Mg-ATPase and Na-Ca exchanger pumps in the renal tubules. Sodium, potassium, phosphate, calcium, magnesium and water losses result from decreased expression of these pumps.
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, Manila, Philippines.
Aileen Azul
AA
Bautista
Department of Medicine, Philippine General Hospital, Manila, Philippines.
Jose Eduardo De Leon
JE
Duya
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, Manila, Philippines.
Mark Anthony Santiago
MA
Sandoval
D000328:Adult; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D007008:Hypokalemia / Q000209:etiology; D007010:Hyponatremia / Q000209:etiology; D017674:Hypophosphatemia / Q000209:etiology; D007037:Hypothyroidism / Q000150:complications* / Q000175:diagnosis; D007674:Kidney Diseases / Q000209:etiology / Q000503:physiopathology; D035002:Lower Extremity; D008297:Male; D018908:Muscle Weakness / Q000209:etiology*; D012008:Recurrence; D012140:Respiratory Tract Diseases / Q000209:etiology*