Unusual presentation of more common disease/injury: Two unusual cases of hypothyroidism with renal dysfunction

摘要

We describe two cases in which the initial finding of renal impairment guided further investigation leading to the diagnosis of hypothyroidism. In the first case, a 40-year-old female patient presented with a complaint of facial puffiness. On investigation, her serum creatinine was 1.86 mg/dl, glomerular filteration rate (GFR) by Cockcroft-Gault equation was 40 ml/min, free throxine (FT4) was <1 mg/dl and a thyroid stimulating hormone (TSH) concentration >80 μ/l. In the second case, a 45-year-old male patient presented with complains of indigestion, weight gain and lethargy. On examination, his blood pressure was 160/100 mm Hg and there was facial puffiness and mild pedal oedema. On investigation, her serum creatinine was 1.5 mg/dl and estimated GFR by Cockcroft-Gault equation was 55 ml/min. Thyroid function was abnormal, FT4 2.99 mg/dl and TSH 80 μ/l. In both the cases, thyroid hormone replacement therapy brought about complete recovery of renal function.