An unusual case of “renal failure”
A 30-year-old male presented with a history of generalized edema and significant weight gain of 20 kg in 6 months. He had tiredness, significant myalgia, and slurring of speech. The creatinine was elevated at 2.12 mg/dL, which was the reason for referral to the nephrologist. Routine investigations revealed a completely normal hemogram and urine analysis, elevated creatinine at 2.17 mg/dL but normal blood urea at 15 mg/dL. Hypothyroidism was suspected, which was confirmed with a T3 of 0.19 ng/mL, T4 of 0.4 μg/mL, and a thyroid stimulating hormone (TSH) of 780 μIU/mL. Creatinine kinase (CK) was 11,365 U/L. He also had abnormal lipid profile and abnormal liver enzymes. Abdominal ultrasound showed completely normal kidneys and mild fatty changes in the liver. Echocardiography was normal. A diagnosis of severe hypothyroidism with myopathy was made and given the normal blood urea, normal urine analysis, and renal ultrasound, the raised creatinine was thought to be secondary to excessive production rather than impaired renal function. He was commenced on thyroxine replacement therapy and a review in 2 weeks revealed a CK of 2,228 U/L and a creatinine of 1.5 mg/dL, both of which had normalized during the subsequent visit.