Publication:

Evaluate all newly diagnosed mild-moderate renal dysfunction patients for primary hypothyroidism

Background Hypothyroidism often presents to nephrologists with elevated serum creatinine which may lead to unnecessary evaluation including renal biopsy.

Methods We retrospectively analysed the data of 24 patients who presented to the department of nephrology at our institute with anasarca/facial puffiness or elevated serum creatinine and diagnosed to have hypothyroidism with TSH >40 µIU/ml.

Results Twelve patients presented with generalised edema, eight patients for evaluation of deranged serum creatinine and four patients with both generalised edema and deranged serum creatinine. Age (r=0.696, p<0.001) and serum thyroid stimulating hormone (r=0.504, p=0.012) had significant positive correlation with serum creatinine whereas serum total thyroxine (r=-0.637, p<0.001) and triiodothyronine (r=-0.728, p<0.001) had significant negative correlation. Serum sodium was lower (<136 mmol/L) in eight patients. Age (r=-0.598, p<0.001), serum creatinine (r=-0.624, p<0.001), and serum thyroid stimulating hormone (r=-0.728, p=0.012) had significant negative correlation with serum sodium whereas serum total thyroxine (r=0.869, p<0.001) and triiodothyronine (r=.845, p<0.001) had significant positive correlation. Serum creatinine and sodium normalised in all after levothyroxine replacement.

Conclusions To conclude, hypothyroidism is not an uncommon cause of mild-moderate renal dysfunction and often presents to nephrologists prompting unnecessary investigations including renal biopsy. Hence, all newly diagnosed mild-moderate renal failure patients should be tested to rule out primary hypothyroidism.