Recurrent Rhabdomyolysis Induced by Severe Hypothyroidism

Abstract

Hypothyroidism is frequently associated with myalgias, muscle stiffness, easy fatigability, and occasionally some degree of myopathy with mildly elevated muscle enzymes. Rarely, hypothyroidism may be complicated by rhabdomyolysis, the rapid destruction of skeletal muscle with myoglobin, creatine kinase, urate, and electrolytes release into the circulation. Recurrent cases of rhabdomyolysis are uncommon as most patients experience only one episode of rhabdomyolysis in their lifetime. Most common causes of such episodes are trauma, epileptic seizures, or medication. We describe a case of a 49-year-old male with a history of hypothyroidism, who repeatedly developed severe rhabdomyolysis precipitated by deep muscle injury, seizure, and poor medication compliance. Interestingly, he never developed any of the complications of rhabdomyolysis despite high levels of serum creatine kinase. The most common and feared complication of rhabdomyolysis is acute kidney injury which can occur in 15 to 50% of patients with rhabdomyolysis. Timely and appropriate fluid resuscitation is the mainstay therapy for acute kidney injury (AKI) prevention. Recurrent rhabdomyolysis in a patient should prompt further investigation if there is a family history of a neuromuscular disorder or exercise intolerance. In a case of refractory hypothyroidism, a patient should be counseled on proper regimen and medication compliance.

Rhabdomyolysis and Hypothyroidism in a Collegiate Hammer Thrower: A Disablement Model Case Study

“…While hypothyroidism is a relatively common condition, it has rarely been associated with rhabdomyolysis. [3][4][5] Furthermore, in this case, the patient's hypothyroidism was discovered due to his rhabdomyolysis. The patient's family history of hypothyroidism gave the physician cause for suspicion.…”

“…1,2 In rare cases, hypothyroidism can be a comorbidity of rhabdomyolysis. [3][4][5] Rhabdomyolysis is a severe and potentially fatal condition characterized by damage to the myocyte membrane. 6 This damage can lead to increased intracellular calcium and muscle and organ tissue destruction.…”

Metabolic Myopathies

“…Hypothyroidism can lead to a fixed myopathy with hyperCKemia 19,20 and weakness, 21 but predisposes to exertional rhabdomyolysis 22-25 . Hypothyroidism can lead to mitochondrial dysfunction and carnitine depletion, 26 which likely explains the relationship to exercise-induced rhabdomyolysis.…”

Acute Renal Injury Due to Rhabdomyolysis Induced by Severe Hypothyroidism: First Case Report from Somalia

“… 3 Although hypothyroidism-related rhabdomyolysis can be encountered in clinical practice, it is a very unusual combination. 4 It has been known that hypothyroidism is associated with some degree of myalgia and muscle stiffness, but it can also be a cause of life-threatening rhabdomyolysis with end-organ damage. 5 Notably, there are some case reports that reported the occurrence of acute renal injury in the presence of hypothyroidism.…”