Abstract:
We present a patient with severe hypothyroidism complicated by paralytic ileus
and acute kidney injury. A 65 year old male patient, diagnosed with
hypothyroidism one year ago was transferred to our unit in a state of drowsiness
and confusion. He was severely hypothyroid and had paralytic ileus and impaired
renal function at the time of transfer. Hypokalaemia was present, and was likely
to have contributed to the paralytic ileus and this together with dehydration was
likely to have contributed to renal injury. Nonetheless, hypothyroidism is very
likely to have been the principal precipitant of both these complications, and
both paralytic ileus and acute kidney injury improved with thyroxine replacement.
Unfortunately, the patient died unexpectedly eight days after admission to the
unit.Hypothyroidism may induce de novo acute kidney injury or it may exacerbate
ongoing chronic kidney disease. This rare complication is assumed to be due to
the hypodynamic circulatory state created by thyroid hormone deficiency.
Paralytic ileus is an even rarer fatal manifestation of hypothyroidism and is
thought to be due to an autonomic neuropathy affecting the intestines that is
reversible with thyroxine replacement. To our knowledge, both these complications
have not been observed in a single patient so far.It is important that clinicians
are aware of these rare manifestations of hypothyroidism as in most occasions,
thyroxine deficiency may be missed, and treatment can reverse the complications.
