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Increased levothyroxine requirements presenting as “inappropriate” TSH secretion syndrome in a patient with nephrotic syndrome

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Abstract

Patients with primary thyroid failure on levothyroxine (LT4) replacement who develop nephrotic syndrome (NS) may rarely present with an increase in LT4 requirements. In this report, we describe a patient with thyroid failure following radioactive iodine ablation for Graves’ disease who required an escalation of LT4 doses following the onset of NS. The case presented with disproportionately elevated TSH levels in the presence of normal (or slightly subnormal) thyroid hormone levels, thus, masquerading as a state of “inappropriate” TSH secretion. This pattern of extreme dysregulation in thyroid function indices due to urinary loss of thyroid hormones has not been previously described in NS, and, therefore, extends the spectrum of endocrine manifestations of NS.

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Authors and Affiliations

  1. National Institute of Dental and Craniofacial Research, USA

    M. T. Collins

  2. Clinical Pathology Department, USA

    A. T. Remaley & G. Csako

  3. Pharmacy Department, Clinical Center, USA

    F. Pucino

  4. USA

    M. C. Skarulis & J. E. Balow

  5. Clinical Endocrinology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Building #10, Room #8D12C, 10 Center Drive, MSC 1758, Bethesda, MD, 20892-1758, USA

    Nicholas J. Sarlis M.D., Ph.D.

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This paper has been presented in part at the 72nd Annual Meeting of the American Thyroid Association (Palm Beach, FL, USA, Sep. 29–Oct. 1, 1999)

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Collins, M.T., Remaley, A.T., Csako, G. et al. Increased levothyroxine requirements presenting as “inappropriate” TSH secretion syndrome in a patient with nephrotic syndrome. J Endocrinol Invest 23, 383–392 (2000). https://doi.org/10.1007/BF03343742

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