[Severe rhabdomyolysis revealing a myopathy linked to autoimmune hypothyroidism]

Severe hypothyroidism-induced rhabdomyolysis: A case report

Hypothyroidism causing rhabdomyolysis is a known but an uncommon entity. Hashimoto's thyroiditis causing rhabdomyolysis in the absence of precipitating factors is even rarer. Here, we report a 42-year-old previously healthy man with hypothyroidism due to Hashimoto's thyroiditis complicated by severe rhabdomyolysis and acute kidney injury in the absence of precipitating factors. The diagnosis was based on his clinical presentation and laboratory investigations, and he was successfully treated with intravenous fluid therapy and oral levothyroxine.

Rhabdomyolysis: a rare complication of Hashimoto's thyroiditis precipitated by statin therapy

Hashimoto's thyroiditis (HT) or chronic lymphocytic thyroiditis is the most common form of primary hypothyroidism. Muscular manifestations like weakness, pain, stiffness and elevated muscle enzymes have been noticed in hypothyroidism. Statins are also known to cause myositis and rhabdomyolysis. This is a case of a middle-aged man, on statin therapy, who presented with severe muscle aches and pain and was found to have rhabdomyolysis. Further evaluation revealed an underlying HT as the culprit for his condition. He was managed with intravenous fluids and levothyroxine along with cessation of statins, following which he improved.

Hypothyroid myopathy: A peculiar clinical presentation of thyroid failure. Review of the literature

Abnormalities in thyroid function are common endocrine disorders that affect 5-10 % of the general population, with hypothyroidism occurring more frequently than hyperthyroidism. Clinical symptoms and signs are often nonspecific, particularly in hypothyroidism. Muscular symptoms (stiffness, myalgias, cramps, easy fatigability) are mentioned by the majority of patients with frank hypothyroidism. Often underestimated is the fact that muscle symptoms may represent the predominant or the only clinical manifestation of hypothyroidism, raising the issue of a differential diagnosis with other causes of myopathy, which sometimes can be difficult. Elevated serum creatine kinase, which not necessarily correlates with the severity of the myopathic symptoms, is certainly suggestive of muscle impairment, though it does not explain the cause. Rare muscular manifestations, associated with hypothyroidism, are rhabdomyolysis, acute compartment syndrome, Hoffman's syndrome and Kocher-Debré-Sémélaigne syndrome. Though the pathogenesis of hypothyroid myopathy is not entirely known, proposed mechanisms include altered glycogenolytic and oxidative metabolism, altered expression of contractile proteins, and neuro-mediated damage. Correlation studies of haplotype, muscle gene expression and protein characterization, could help understanding the pathophysiological mechanisms of this myopathic presentation of hypothyroidism.

Rhabdomyolysis: A rare complication of hypothyroidism

Hypothyroidism is known to be associated with muscle pain, weakness, stiffness and mildly elevated muscle enzymes. However, rhabdomyolysis due to hypothyroidism is very rare, especially in the absence of any precipitating factors, such as heavy exercise, alcohol or medication. We report a case of rhabdomyolysis associated with hypothyroidism in a 24-year-old man who presented with choking sensation, generalized lethargy, low backache and facial swelling with markedly raised muscle enzymes which normalized after thyroxine replacement.