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The Journal of the Royal Society for the Promotion of Health
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Lessons to be learned: a case study approach

Severe hyponatraemia induced by primary hypothyroidism and associated with possible increased hepatic sensitivity to thyroxine replacement

Adebayo Olukoga, MB, BS, FWACP, MRCPath

Department of Clinical Biochemistry, Hope Hospital, Salford, Manchester

Graham Horsman, MB, BS, MRCP, MRCPath

Department of Clinical Biochemistry, Hope Hospital, Salford, Manchester

Felicity Stewart, MB, BS, MD, MRCPath

Department of Clinical Biochemistry, Hope Hospital, Salford, Manchester

The case is presented of a 74 year-old woman who was admitted with severe hypo-osmolar hyponatraemia associated with inappropriately raised urinary osmolality, and who was subsequently discovered to have primary hypothyroidism. A normal serum sodium concentration was restored by means of judicious fluid restriction and thyroid hormone replacement. Low dose thyroxine therapy led to rapid but modest increases in the serum activities of alanine aminotransferase (ALT) and alkaline phosphatase (ALP); both returned to normal over a period of three weeks. These sub- clinical enzyme changes may indicate tissue 'hyperthyroidism'; and in this case, the fact that they occurred acutely at only low doses of thyroxine possibly suggests an increased hepatic sensitivity to the hormone.

Key Words: Alanine transaminase (ALT) • alkaline phosphatase (ALP) • antidiuresis • hyponatraemia • primary hypothyroidism

The Journal of the Royal Society for the Promotion of Health, Vol. 119, No. 2, 117-120 (1999)
DOI: 10.1177/146642409911900212
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