SHM Converge Scientific Abstract ePoster Gallery-Hidden Culprit: Hypothyroidism as a Reversible Cause of Acute Kidney Injury

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This case report describes a 77-year-old man with hypertension, type 2 diabetes, and stage 3a chronic kidney disease who presented with generalized weakness and fatigue, but no clear urinary symptoms, myalgias, or cold intolerance. Admission labs showed severe acute kidney injury with a BUN of about 57–60 mg/dL, creatinine 5.93 mg/dL, and eGFR 12 mL/min. Workup did not reveal nephrotoxic medication use, rhabdomyolysis, urinary obstruction, or other intrinsic renal causes. Renal ultrasound showed chronic medical renal disease changes only.<br /><br />Thyroid testing uncovered profound hypothyroidism, with a markedly elevated TSH (reported as 166 mIU/L initially) and very low free T4 (0.13 ng/dL), with low/normal T3. The patient was started on levothyroxine 50 mcg daily, and sodium bicarbonate was added for metabolic acidosis. Kidney function improved rapidly during hospitalization: creatinine fell to 2.02 mg/dL and eGFR rose to 38 mL/min by day 3. At 6-week follow-up, thyroid function had normalized substantially (TSH 4.15 mIU/L, free T4 1.34–1.37 ng/dL), and renal function returned near baseline (creatinine 1.65 mg/dL, eGFR 42 mL/min).<br /><br />The report emphasizes that hypothyroidism can reduce renal blood flow, lower GFR, and impair tubular function through decreased cardiac output and altered RAAS activity. Because symptoms may be nonspecific, hypothyroidism should be considered in the differential diagnosis of unexplained AKI, especially in patients with chronic kidney disease. Prompt thyroid hormone replacement can reverse renal dysfunction and potentially prevent unnecessary invasive evaluation.

Asset Subtitle

Zoya Khan

Meta Tag

Author List Felix Carrillo-Alvira, Shrinand Shah, Vasu Malhotra, DO, Zein Barakat, Zoya Khan

Category Clinical Vignettes

Concept Hypothyroidism

Concept Acute Kidney Injury

Concept Thyroid-Stimulating Hormone

Concept Free Thyroxine

Concept Levothyroxine

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Zoya Khan

Track Adult

Keywords

hypothyroidism

acute kidney injury

chronic kidney disease

levothyroxine

elevated TSH

low free T4

renal dysfunction

generalized weakness

fatigue

thyroid replacement

Hypothyroidism

Acute Kidney Injury

Thyroid-Stimulating Hormone

Free Thyroxine

Levothyroxine