Atorvastatin-Diltiazem Combination Induced Rhabdomyolysis Leading to Diagnosis of Hypothyroidism
Statins and hypothyroidism, independently, can rarely cause rhabdomyolysis. The combination of them especially with concurrent intake of drugs such as diltiazem increases the risk of rhabdomyolysis. Hashimoto’s encephalopathy is a rare condition associated with Hashimoto’s thyroiditis and some patie...
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| Format: | Article |
| Language: | English |
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Wiley
2017-01-01
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| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2017/8383251 |
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| author | N. D. B. Ehelepola S. M. B. Y. Sathkumara H. M. P. A. G. S. Bandara K. L. R. Kalupahana |
| author_facet | N. D. B. Ehelepola S. M. B. Y. Sathkumara H. M. P. A. G. S. Bandara K. L. R. Kalupahana |
| author_sort | N. D. B. Ehelepola |
| collection | DOAJ |
| description | Statins and hypothyroidism, independently, can rarely cause rhabdomyolysis. The combination of them especially with concurrent intake of drugs such as diltiazem increases the risk of rhabdomyolysis. Hashimoto’s encephalopathy is a rare condition associated with Hashimoto’s thyroiditis and some patients with that can present with a stroke like picture. An elderly male who has been on atorvastatin for three years and on diltiazem for a week presented with sudden onset inability to walk and confusion. On examination muscle tenderness was noticed and creatine kinase levels indicated rhabdomyolysis which we attributed to atorvastatin. Patient developed a seizure and myoclonus of masseters. Considering this, his confusion and his neutrophilia and high C-reactive protein levels, empirical antibiotics with dexamethasone were started and the patient responded to that. His cerebrospinal fluid and blood culture reports that arrived later did not show sepsis. After going home also his CK (creatine kinase) levels remained high; TSH (thyroid-stimulating hormone) level test was done and hypothyroidism was diagnosed. His antithyroid peroxidase antibody levels were also very high. We retrospectively think he had Hashimoto’s encephalopathy as well. His lipid profile and TSH and CK values returned to normal in that order after a few months of levothyroxine therapy. |
| format | Article |
| id | doaj-art-e0fc07357a4d4a0388e42c7ee2ba8baa |
| institution | Kabale University |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Medicine |
| spelling | doaj-art-e0fc07357a4d4a0388e42c7ee2ba8baa2025-02-03T05:57:21ZengWileyCase Reports in Medicine1687-96271687-96352017-01-01201710.1155/2017/83832518383251Atorvastatin-Diltiazem Combination Induced Rhabdomyolysis Leading to Diagnosis of HypothyroidismN. D. B. Ehelepola0S. M. B. Y. Sathkumara1H. M. P. A. G. S. Bandara2K. L. R. Kalupahana3The Teaching (General) Hospital-Kandy, Kandy, Sri LankaThe Teaching (General) Hospital-Kandy, Kandy, Sri LankaThe Teaching (General) Hospital-Kandy, Kandy, Sri LankaThe Teaching (General) Hospital-Kandy, Kandy, Sri LankaStatins and hypothyroidism, independently, can rarely cause rhabdomyolysis. The combination of them especially with concurrent intake of drugs such as diltiazem increases the risk of rhabdomyolysis. Hashimoto’s encephalopathy is a rare condition associated with Hashimoto’s thyroiditis and some patients with that can present with a stroke like picture. An elderly male who has been on atorvastatin for three years and on diltiazem for a week presented with sudden onset inability to walk and confusion. On examination muscle tenderness was noticed and creatine kinase levels indicated rhabdomyolysis which we attributed to atorvastatin. Patient developed a seizure and myoclonus of masseters. Considering this, his confusion and his neutrophilia and high C-reactive protein levels, empirical antibiotics with dexamethasone were started and the patient responded to that. His cerebrospinal fluid and blood culture reports that arrived later did not show sepsis. After going home also his CK (creatine kinase) levels remained high; TSH (thyroid-stimulating hormone) level test was done and hypothyroidism was diagnosed. His antithyroid peroxidase antibody levels were also very high. We retrospectively think he had Hashimoto’s encephalopathy as well. His lipid profile and TSH and CK values returned to normal in that order after a few months of levothyroxine therapy.http://dx.doi.org/10.1155/2017/8383251 |
| spellingShingle | N. D. B. Ehelepola S. M. B. Y. Sathkumara H. M. P. A. G. S. Bandara K. L. R. Kalupahana Atorvastatin-Diltiazem Combination Induced Rhabdomyolysis Leading to Diagnosis of Hypothyroidism Case Reports in Medicine |
| title | Atorvastatin-Diltiazem Combination Induced Rhabdomyolysis Leading to Diagnosis of Hypothyroidism |
| title_full | Atorvastatin-Diltiazem Combination Induced Rhabdomyolysis Leading to Diagnosis of Hypothyroidism |
| title_fullStr | Atorvastatin-Diltiazem Combination Induced Rhabdomyolysis Leading to Diagnosis of Hypothyroidism |
| title_full_unstemmed | Atorvastatin-Diltiazem Combination Induced Rhabdomyolysis Leading to Diagnosis of Hypothyroidism |
| title_short | Atorvastatin-Diltiazem Combination Induced Rhabdomyolysis Leading to Diagnosis of Hypothyroidism |
| title_sort | atorvastatin diltiazem combination induced rhabdomyolysis leading to diagnosis of hypothyroidism |
| url | http://dx.doi.org/10.1155/2017/8383251 |
| work_keys_str_mv | AT ndbehelepola atorvastatindiltiazemcombinationinducedrhabdomyolysisleadingtodiagnosisofhypothyroidism AT smbysathkumara atorvastatindiltiazemcombinationinducedrhabdomyolysisleadingtodiagnosisofhypothyroidism AT hmpagsbandara atorvastatindiltiazemcombinationinducedrhabdomyolysisleadingtodiagnosisofhypothyroidism AT klrkalupahana atorvastatindiltiazemcombinationinducedrhabdomyolysisleadingtodiagnosisofhypothyroidism |