Rhabdomyolysis and Hashimoto's Thyreoiditis - Case Report and Literature Review

Clinical signs of rhabdomyolysis consist in myalgia, strong elevation of CK in the serum and myoglobinuria. Besides being caused by physical trauma, myotoxic drugs, infections, alcohol and drug abuse, rhabdomyolysis may also occur due to endocrinological disorders and autoimmune disease. Potential complications include acute renal failure and compartment syndrome. Early recognition of the cause underlying rhabdomyolysis allows adequate treatment and is important for the prevention of such complications. Here we present the clinical case of a 44-year-old female patient presenting with severe myalgia and CK serum concentration of 8 830 IU/l. In addition the patient exhibited pericardial effusion, vocal cord myxedema and developed acute renal failure in the clinical course. Under treatment with L-Thyroxin and intravenous volume replacement therapy the patient's symptoms improved rapidly. As underlying cause for rhabdomyolysis we diagnosed Hashimoto's thyroiditis. An isolated hypothyroidism as single cause of rhabdomyolysis is rare. In literature, published cases of rhabdomyolysis frequently exhibit cofactors in the patients' medical history, mostly treatment with HMG-CoA reductase inhibitors. When patients present with myalgia and elevated CK serum concentration as cardinal symptoms, apart from other causes, Hashimoto's thyroiditis should be considered. In these cases, hormone substitution therapy as well as an adequate symptomatic treatment helps to prevent severe complications.