CLINICAL HYPOTHYROIDISM IN STEROID SENSITIVE NEPHROTIC SYNDROME IN A YOUNG BOY

Abstract

Background:
Nephrotic Syndrome is damage to kidney that leads to the hyperfiltration and excretion of protein in urine. Persistent proteinuria causes progressive oedema, Hypoalbuminemia and Hypercholesteremia. Many associated manifestations can be possible with the disease either due to genetic susceptibility or complications secondary to proteinuria including transient hypothyroidism due to loss of thyroxine binding globulin, transthyretin and albumin in urine.
Case Presentation:
We report a case of 10 years old male patient previously well, presented with generalized body swelling for 1 month, constipation, lethargy and somnolence for 3 weeks.
Clinically he had Anasarca, massive ascites and signs of pleural effusion. Labs revealed Hypoalbuminemia, Hypercholesterolemia and Protein+3 in dipstick with Urine PCR of 3.8. TSH=21 significantly high. Secondary causes excluded and Paediatrics nephrology consult taken, advised to give steroid and Thyroxine for symptomatic Hypothyroidism.
Conclusion:
As patient achieved complete remission after 4 weeks of daily methylprednisolone, Thyroxine also tapered with tapering dose of steroids and stopped at 12 weeks of treatment. Patients showed complete response with treatment and no relapses till 1 year of follow up.
Keywords:
Clinical hypothyroidism, Steroid-sensitive nephrotic syndrome, Paediatric nephrology