Acute-on-Chronic Kidney Injury in Thyroid Hormone Withdrawal: A Case with
Possible Implications for Radioactive Iodine Planning
#MMPMID26351591
McAninch EA
; Lagari VS
Case Rep Endocrinol
2015[]; 2015
(?): 932372
PMID26351591
show ga
The association between renal dysfunction and hypothyroidism is of increasing
clinical importance as thyroid hormone replacement may attenuate decline in renal
function and improve cardiovascular outcomes in patients with chronic kidney
disease (CKD). Although multiple mechanisms for the induction of renal
insufficiency in hypothyroidism have been described, the renal impact of
short-term, acute hypothyroidism is unknown, which has possible implications for
thyroid cancer patients preparing to receive radioactive iodine (RAI). A
56-year-old gentleman with history of unilateral renal agenesis and CKD stage III
presented with intermediate-risk papillary thyroid cancer. In preparation for
RAI, he underwent thyroid hormone withdrawal (THW) associated with acute kidney
injury (AKI), as marked by a decrease in his estimated GFR from 53 to
32?mL/min/1.73?m(2). Upon resumption of thyroid hormone, renal function returned
to baseline within months. Although AKI in this case was not otherwise associated
with adverse outcome and reversed upon resumption of thyroid hormone, it is
possible that this phenomenon could result in potential harm, particularly in the
patient with baseline renal insufficiency. In CKD patients, preparation for RAI
therapy may require special consideration; future studies should address the role
of recombinant TSH to mitigate deleterious renal effects of acute hypothyroidism
in this setting.
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