Rhabdomyolysis in a patient with postoperative hypothyroidism and hypoparathyroidism

The patient was an 81-year-old woman with postoperative hypothyroidism and hypoparathyroidism who developed rhabdomyolysis and acute renal failure. She had been on levothyroxine and vitamin D replacement therapy for 35 years following removal of the thyroid and parathyroid for Grave's disease, although her drug compliance had been poor for 6 months prior to admission due to senile dementia. She presented with anorexia, general malaise and gait disturbance. Rhabdomyolysis was diagnosed by elevated CK and serum myoglobin, and the difference between urinary blood occult reaction and red blood cell count. BUN and serum creatinine levels were 44.3 mg/dL and 1.9 mg/dL, respectively. The patient was immediately administered intravenous fluid and was started on levothyroxine and alfacalcidol replacement therapy, which improved the symptoms and laboratory findings. To the author's knowledge, this is the first case of rhabdomyolysis caused by both hypothyroidism and hypoparathyroidism.