Skip to main content
NCBI home page
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2003 Oct;95(10):991–994.

Life-threatening hyponatremia due to cessation of L-thyroxine.

Ramazan Sari 1, Alper Sevinc 1
PMCID: PMC2594489  PMID: 14620714

Abstract

Electrolyte disorders in hypothyroidism are frequently subtle and rarely observed in clinical practice. A 50-year-old woman was admitted to the emergency room with complaints of nausea, weakness, and lethargy. Her medical history revealed total thyroidectomy two years earlier. She was commenced on L-thyroxine after the surgery. However, the patient stopped the treatment for three months. Thyroid function tests showed free T3 0.80 pg/ml (n: 1.8-4.2), free T4 <0.20 ng/dl (n: 0.8-1.9), TSH 56.84 microU/ml (n: 0.4-4.0). Her biochemical and laboratory investigations were normal, except for a plasma sodium value of 114 mmol/L (n: 135-145). Hypertonic saline treatment with L-thyroxine was immediately started. Symptomatic hyponatremia caused by hypothyroidism was the direct consequence of cessation of L-thyroxine treatment. The patient was followed up for a year and still using L-thyroxine (0.1 mg). In conclusion, it should be kept in mind that life-threatening hyponatremia may occur in patients with total thyroidectomy-induced hypothyroidism; L-thyroxine should be immediately started if stopped for any reason.

Full text

PDF
991

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baajafer F. S., Hammami M. M., Mohamed G. E. Prevalence and severity of hyponatremia and hypercreatininemia in short-term uncomplicated hypothyroidism. J Endocrinol Invest. 1999 Jan;22(1):35–39. doi: 10.1007/BF03345476. [DOI] [PubMed] [Google Scholar]
  2. Fujikawa M., Okamura K., Sato K., Mizokami T., Shiratsuchi M., Fujishima M. Increased sensitivity to thyroid hormone replacement therapy followed by hyponatremia and eosinophilia in a patient with long-standing young-onset primary hypothyroidism. J Endocrinol Invest. 1999 Jun;22(6):476–480. doi: 10.1007/BF03343593. [DOI] [PubMed] [Google Scholar]
  3. Hanna F. W., Scanlon M. F. Hyponatraemia, hypothyroidism, and role of arginine-vasopressin. Lancet. 1997 Sep 13;350(9080):755–756. doi: 10.1016/S0140-6736(05)62563-9. [DOI] [PubMed] [Google Scholar]
  4. Hochberg Z., Benderly A. Normal osmotic threshold for vasopressin release in the hyponatremia of hypothyroidism. Horm Res. 1983;17(3):128–133. doi: 10.1159/000179687. [DOI] [PubMed] [Google Scholar]
  5. Iranmanesh A., Lizarralde G., Johnson M. L., Veldhuis J. D. Dynamics of 24-hour endogenous cortisol secretion and clearance in primary hypothyroidism assessed before and after partial thyroid hormone replacement. J Clin Endocrinol Metab. 1990 Jan;70(1):155–161. doi: 10.1210/jcem-70-1-155. [DOI] [PubMed] [Google Scholar]
  6. Koide Y., Oda K., Shimizu K., Shimizu A., Nabeshima I., Kimura S., Maruyama M., Yamashita K. Hyponatremia without inappropriate secretion of vasopressin in a case of myxedema coma. Endocrinol Jpn. 1982 Jun;29(3):363–368. doi: 10.1507/endocrj1954.29.363. [DOI] [PubMed] [Google Scholar]
  7. Macaron C., Famuyiwa O. Hyponatremia of hypothyroidism. Appropriate suppression of antidiuretic hormone levels. Arch Intern Med. 1978 May;138(5):820–822. doi: 10.1001/archinte.138.5.820. [DOI] [PubMed] [Google Scholar]
  8. Mizuno O. [Increased plasma antidiuretic hormone in the presence of hyponatremia in primary hypothyroidism]. Nihon Naibunpi Gakkai Zasshi. 1993 Nov 20;69(10):1069–1075. doi: 10.1507/endocrine1927.69.10_1069. [DOI] [PubMed] [Google Scholar]
  9. Montenegro J., González O., Saracho R., Aguirre R., González O., Martínez I. Changes in renal function in primary hypothyroidism. Am J Kidney Dis. 1996 Feb;27(2):195–198. doi: 10.1016/s0272-6386(96)90539-9. [DOI] [PubMed] [Google Scholar]
  10. Montiel M., Jiménez E., Narváez J. A., Morell M. Renin-angiotensin-aldosterone system in hyper- and hypothyroid rats during sodium depletion. Endocr Res Commun. 1982;9(3-4):249–260. doi: 10.3109/07435808209045768. [DOI] [PubMed] [Google Scholar]
  11. Okuno S., Inaba M., Nishizawa Y., Miki T., Inoue Y., Morii H. A case of hyponatremia in panhypopituitarism caused by the primary empty sella syndrome. Endocrinol Jpn. 1987 Apr;34(2):299–307. doi: 10.1507/endocrj1954.34.299. [DOI] [PubMed] [Google Scholar]
  12. Salomez-Granier F., Lefebvre J., Racadot A., Dewailly D., Linquette M. Taux d'hormone antidiurétique (arginine-vasopressine) en cas d'hypothyroïdie périphérique. 26 observations. Presse Med. 1983 Apr 9;12(16):1001–1004. [PubMed] [Google Scholar]
  13. Shalev O., Naparstek Y., Brezis M., Ben-Yishai D. Hyponatremia in myxedema: a suggested therapeutic approach. Isr J Med Sci. 1979 Nov;15(11):913–916. [PubMed] [Google Scholar]
  14. Waters A. K. Increased vasopressin excretion in patients with hypothyroidism. Acta Endocrinol (Copenh) 1978 Jun;88(2):285–290. doi: 10.1530/acta.0.0880285. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES