SHM Converge Scientific Abstract ePoster Gallery-Hashimoto's Thyroiditis Associated With Rhabdomyolysis After Infection With Covid19

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This case report describes a 74-year-old woman with three hospitalizations in 2022 for severe rhabdomyolysis, later linked to newly recognized Hashimoto’s thyroiditis and possibly triggered by COVID-19 infection. After a COVID-19 infection, she first presented with generalized weakness, body aches, dyspnea, fever, chills, oliguria, acute renal failure, and a creatine kinase (CK) level of 42,600, requiring temporary outpatient hemodialysis. A thyroid test was not obtained during this admission.<br /><br />Five months later, she was readmitted with similar symptoms and even more severe muscle injury, with CK greater than 50,000 and a thyroid-stimulating hormone (TSH) of 177.95, indicating profound hypothyroidism. She was treated with IV fluids, IV levothyroxine, and IV hydrocortisone. Because of concern for autoimmune myositis, intravenous immunoglobulin (IVIG) was added while awaiting biopsy results. The muscle biopsy was negative for myositis, but her CK and creatinine improved markedly after IVIG, and her strength and fatigue gradually returned to baseline.<br /><br />Her third admission occurred after complications from the biopsy site, including major blood loss, altered mental status, and a large intramuscular hematoma. She required ICU care and blood transfusions, then recovered and was discharged with walker assistance and baseline mental status.<br /><br />The authors suggest a possible relationship between COVID-19, Hashimoto’s thyroiditis, and severe rhabdomyolysis. They emphasize that thyroid dysfunction should be considered and TSH testing may be useful in hospitalized patients with unexplained rhabdomyolysis or weakness.

Asset Subtitle

Nova B. Mebane

Meta Tag

Author List Cynthia Salloum, Daniel Park, Neva Mebane, Nova B. Mebane

Category Clinical Vignettes

Concept Severe Hypothyroidism

Concept Hashimoto Thyroiditis

Concept Rhabdomyolysis

Concept Creatine Kinase

Concept Thyroid-Stimulating Hormone

Distinguished Non-Finalist

Presenter Organization Corpus Christi Medical Center

Presenting Author Nova B. Mebane

Track Adult

Keywords

rhabdomyolysis

Hashimoto's thyroiditis

COVID-19 infection

hypothyroidism

creatine kinase

acute renal failure

intravenous immunoglobulin

muscle biopsy

thyroid-stimulating hormone

hospitalization

Severe Hypothyroidism

Hashimoto Thyroiditis

Rhabdomyolysis

Creatine Kinase

Thyroid-Stimulating Hormone