Acute kidney injury and paralytic ileus- An unusual presentation of hypothyroidism

A 55 year old male patient, known case of hypothyroidism since last four years was admitted to our nephrology unit in a state of drowsiness and confusion. He had paralytic ileus and impaired renal functions at the time of admission. On routine investigations hypokalemia was present, which likely contributed to the paralytic ileus and together with dehydration had lead to renal injury. Nonetheless, hypothyroidism would have been the principal precipitant of both these complications. Both paralytic ileus and acute kidney injury improved with thyroxine replacement. Hypothyroidism may induce de novo acute kidney injury or it may exacerbate ongoing chronic kidney disease. This rare complication is assumed to be due to the hypodynamic circulatory state as a consequence of thyroid hormone deficiency. Paralytic ileus is even a rarer fatal manifestation of hypothyroidism and is thought to be due to autonomic neuropathy affecting the intestines that can be reversed by the thyroxine replacement.