Hypothyroidism causing paralytic ileus and acute kidney injury - case report

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.Hypothyroidism presenting with acute kidney injury is rare, with only few cases reported so far [1,2]. Hypothyroidism may induce de novo acute kidney injury (AKI) or may exacerbate ongoing chronic kidney disease[3] or contribute to the occurrence of AKI in the presence of other renal insults. AKI is life threatening, and identification of possible contributory causes and early treatment is potentially life saving. Paralytic ileus is an even rarer fatal manifestation of hypothyroidism [4]. In this article we discuss a patient presenting with severe hypothyroidism and both these complications.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 did not have any other comorbidities and the cause for hypothyroidism was unknown. He had been on thyroxine replacement (150 μg daily) but had defaulted treatment for 3 months. In the months prior to admission, he had complained of constipation, lethargy, coarse skin and family members had noticed mental slowing, hoarse voice and changes in facial appearance. The patient was first admitted to a local hospital in a state of confusion and drowsiness with generalized body swelling, where oral thyroxine replacement was started. Coincidentally, he fell