PROTEINURIA SECONDARY TO HYPERTHYROIDISM: A CASE STUDY

Abstract

A 28-year-old Indian female presented to the endocrinologist with complaints of dryness of mouth, excessive thirst and loss of almost 8 kg of weight in the past 18 months. On further questioning, the patient revealed to have a good appetite, regular periods, no tremors or palpitation or heat intolerance. The patient has no previous history of any chronic diseases and was not any therapy. Clinical examination of the patient revealed tachycardia, mild tremors, and a diffuse thyromegaly however; no lymph node hyperthyroid related symptoms, no bruit, EOM normal or lid lag was detected. Her physical and vital signs at the time of presentation of the case were- weight: 43.0 kg, hip: 84 cm, waist: 78 cm, waist to hip ratio: 0.93, pulse: 90 bpm. The biochemical investigation report of the patient reveals the parameters to be within normal range (random glucose: 105 mg / dL, urea: 42 mg / dL, serum creatinine: 0.6 mg / dL, uric acid: 4.5 mg / dL, sodium: 142 mMol / L, potassium: 4.0 mMol / L, chloride: 110 mMol / L). The hematological examination was found to be normal for most of the parameters (hemoglobin: 13.5 g / dL, packed cell volume: 40.4, WBC: 5.27 mill / cu.mm, mean corpuscular volume: 79 fL, mean corpuscular hemoglobin concentration: 33.4 g / dL, total WBC count: 9200 cells / cu.mm, neutrophils: 60%, lymphocytes: 34%, eosinophils: 03%, monocytes: 3%, basophils: 0%, absolute neutrophil count: 5.52 X 103 / µl, absolute lymphocyte count: 3.13 X 103 / µl, absolute eosinophil count: 0.28 X 103 / µl, absolute monocyte count: 0.28 X 103 / µl, absolute basophil count: 0.00 X 103 / µl, platelet count: 250 X 103 / µl, ESR: 8 mm / hr). However, mean corpuscular hemoglobin was found to be 25.6 pg along with DW-CV: 11.1%, DW-SD: 29.91 fL, SGOT/AST: 33 U/L, SGPT/ALT: 46 U / L, and alkaline phosphatase: 129 U / L. Also, alarming were her thyroid function test results, T3: 5.40 ng / ml while T4 was 28.5 µg / dl and TSH: < 0.010 µlU / ml; proteinuria was also detected. The clinician diagnosed these values as an indication of hyperthyroidism related to Graves diseases/thyroiditis. However, further examination is required to understand the cause of proteinuria and hyperthyroidism. Meanwhile, the patient was immediately instructed to initiate the therapy of non-selective beta-blocker, propranolol 40 mg for symptomatic relief.