Poster 06: Multisystem presentation of severe hypothyroidism

29 year old male presented to GP with tiredness and leg swelling: creatinine 157umol/L (eGFR 45mL/min). He was referred to nephrology: no proteinuria detected, ultrasound showed structurally normal kidneys. There was mild anaemia (Hb 100-110g/L), neutropenia (1.2-1.9x109/L) and elevated transaminases (AST 170:ALT 107U/L). Bone marrow was hypocellular with islands of normal cellularity; cytogenetics normal.  Liver screen was negative and biopsy showed steatosis, haemosiderosis and ground glass change similar to inherited metabolic disorders. A small pericardial effusion was demonstrated on CT chest/abdomen/pelvis but radiological tests were otherwise unremarkable.

TFT were checked 18 months following presentation: Free T4 <1.3pmol/L and TSH 333mU/L (anti-TPO antibodies positive [69iU/mL]). Levothyroxine 125mcg once daily was commenced. At 2 months, symptoms settled with normalisation of TFT corresponding to complete resolution of renal impairment and transaminitis. At 6 months, haematological abnormalities also returned to normal.

We describe three unusual complications of severe hypothyroidism with complete recovery of abnormalities following 6 months of thyroxine replacement. This highlights importance of checking TFT in the patient with unexplained renal impairment, anaemia/cytopenia or liver abnormalities.