Proteinuria and Hypothyroidism: Two cases illustrating a bidirectional thyroid-kidney relationship
https://doi.org/10.15605/jafes.041.S1
- Author:
Manoharan Thunissha
1
;
Yueh Kuan
1
Author Information
1. Endocrine Unit, Miri Hospital
- Publication Type:Journal Article
- MeSH:
Hypothyroidism;
Proteinuria;
Kidney
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):18-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:The thyroid-kidney axis represents a clinically significant bidirectional relationship. Nephrotic syndrome (NS) may induce
hypothyroidism via urinary hormonal and binding protein losses, while severe hypothyroidism may mimic NS and
contribute to renal dysfunction.
Cases:A 64-year-old male with gout, presented with facial puffiness, pedal edema, weight gain and frothy urine. Investigations
revealed severe hypothyroidism FT4 <0.5 pmol/L (12–22 pmol/L) TSH 314 mIU/L (0.27–4.2 mIU/L) with NS – UPCR
7.7 3 g/L (0.04–0.15 g/L), albumin 22 g/L, total cholesterol 15.9 mmol/L – and renal impairment (eGFR 58 mL/min/1.73
m²). Positive anti-TPO antibodies suggested Hashimoto’s thyroiditis. He was initiated on liothyronine, hydrocortisone,
levothyroxine and diuretics. Although FT4 normalized (14.4 pmol/L) a month later, renal function worsened requiring
dialysis. Further evaluation including renal biopsy demonstrated IgA nephropathy as the underlying cause of NS and
renal failure. Treatment with prednisolone led to gradual improvement in renal function and proteinuria (UPCR 0.21 g/L).
A 73-year-old male with hypothyroidism diagnosed 6 months prior (FT4 11.9 pmol/L, TSH 7.23 mIU/L) for thyroxine
replacement, diabetes, hypertension, dyslipidemia and CKD presented with anasarca, decompensated heart failure, pleural
and pericardial effusions requiring ventilatory and inotropic support. On admission, he had marked hypothyroidism (FT4
2.9 pmol/L and TSH 97.2 mIU/L) and moderate proteinuria (UPCR 0.81 g/L). He was similarly treated with liothyronine,
hydrocortisone and levothyroxine. Renal function initially deteriorated (creatinine 439 µmol/L, eGFR 11 mL/min/1.73 m²)
but later returned to baseline with clinical recovery. Despite normalization of FT4 months later, proteinuria persisted; but
renal function remained stable.
Conclusion:These cases highlight the overlapping manifestations of severe hypothyroidism and renal dysfunction with proteinuria.
Each may mimic or exacerbate the other. NS may unmask underlying hypothyroidism. While inadequately treated
hypothyroidism can worsen proteinuric CKD exacerbating hypothyroidism. Concurrent evaluation of both systems
is essential to prevent misdiagnosis and guide timely management.
- Full text:2026072811085579045BC_A006.pdf
