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COMMENTARY
Year : 2020  |  Volume : 13  |  Issue : 3  |  Page : 242-243  

Hyponatremia and hypothyroidism


Department of Community Medicine, Dr DY Patil University, Pune, Maharashtra, India; Department of Medical Science, Faculty of Medicine, University of Nis, Nis, Serbia; Department of Biological Science Joseph Ayobabalola University, Ikeji- Arakeji, Osun State, Nigeria; Departement of Laboratory Medicine, Chulalongkorn University, Bangkok, Thailand

Date of Submission28-May-2019
Date of Decision15-Oct-2019
Date of Acceptance15-Oct-2019
Date of Web Publication3-Jun-2020

Correspondence Address:
Viroj Wiwanitkit
Chulalongkorn University, Bangkok

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_145_19

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How to cite this article:
Wiwanitkit V. Hyponatremia and hypothyroidism. Med J DY Patil Vidyapeeth 2020;13:242-3

How to cite this URL:
Wiwanitkit V. Hyponatremia and hypothyroidism. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Jul 4];13:242-3. Available from: http://www.mjdrdypv.org/text.asp?2020/13/3/242/285753



Hypothyroidism is an important endocrine disorder. In clinical practice, this condition is a significant thyroid disease. There are many metabolic complications in patients with hypothyroidism. An electrolyte imbalance is a possible clinical challenge. In a publication in the journal,[1] decreased serum sodium is observable. In fact, abnormal serum sodium is an important but little mentioned metabolic alteration seen in patients with hypothyroidism.[2],[3],[4] Low serum sodium is observable, and the type of hyponatremia is euvolemic. The main pathomechanism is the decreased capacity of free water excretion due to hypothyroidism-related, cardiac output-induced increased antidiuretic hormone levels.[2] The incidence of this problem is about 4%.[5] Nevertheless, there are often additional nonthyroid-related factors causing hyponatremia.[6] Some researchers propose that hyponatremia is only a coincidence in a patient with hypothyroidism.[6],[7] It is suggested that blood sodium investigation should be done in any patient with hypothyroidism.[3],[4] On the other hand, the investigation for thyroid function test should be done in any patient presenting with hyponatremia.[8] In a recent report from Japan, 1.3% of patients with hyponatremia had hypothyroidism.[8] Additionally, hyponatremia might co-occur with hypercreatinemia in patients with hypothyroidism.[9] Nevertheless, hypercreatinemia is more common than hyponatremia in patients with hypothyroidism.[9] Hypothyroidism-related hyponatremia can be seen in any group of patients, ranging from infants to elderly people.[10] Pediatric patients might develop a clinical complex of massive myxedema, hyponatremia, and hypothermia.[11] Hyponatremia can be managed and returned to normal if there is an appropriate management of hypothyroidism by thyroid hormone therapy.[3] Finally, there should also be an investigation for other possible additional endocrine disorder that might cause hyponatremia. Another important endocrine problem that can induce hyponatremia is hypoadrenalism.[12] There is a possibility that a patient might have both central hypothyroidism and central hypoadrenalism.[12] More complex conditions such as Sheehan's syndrome [13] and Schmidt's syndrome [14] should also be added in the differential diagnostic list. In conclusion, severe hypothyroidism may be the cause of hyponatremia. Patients with chronic hypothyroidism should be evaluated for hyponatremia. It is an uncommon condition that probably occurs in severe hypothyroidism or myxedema. All hypothyroid patients with low serum sodium levels should be evaluated for other causes and superimposed factors of hyponatremia and treated accordingly. Physicians should not forget to look for electrolyte imbalance in hypothyroid patients.



 
  References Top

1.
Evaluation of significance of hyponatremia in hypothyroidism in an urban female population of eastern India – A cross sectional study. Med J DY Patil Vidyapeeth 2020;13:240-6.  Back to cited text no. 1
    
2.
Liamis G, Filippatos TD, Liontos A, Elisaf MS. Management of endocrine disease: Hypothyroidism-associated hyponatremia: Mechanisms, implications and treatment. Eur J Endocrinol 2017;176:R15-20.  Back to cited text no. 2
    
3.
Kimura T. Potential mechanisms of hypothyroidism-induced hyponatremia. Intern Med 2000;39:1002-3.  Back to cited text no. 3
    
4.
Nakano M, Higa M, Ishikawa R, Yamazaki T, Yamamuro W. Hyponatremia with increased plasma antidiuretic hormone in a case of hypothyroidism. Intern Med 2000;39:1075-8.  Back to cited text no. 4
    
5.
Vannucci L, Parenti G, Simontacchi G, Rastrelli G, Giuliani C, Ognibene A, et al. Hypothyroidism and hyponatremia: Data from a series of patients with iatrogenic acute hypothyroidism undergoing radioactive iodine therapy after total thyroidectomy for thyroid cancer. J Endocrinol Invest 2017;40:49-54.  Back to cited text no. 5
    
6.
Wolf P, Beiglböck H, Smaijs S, Wrba T, Rasoul-Rockenschaub S, Marculescu R, et al. Hypothyroidism and hyponatremia: Rather coincidence than causality. Thyroid 2017;27:611-5.  Back to cited text no. 6
    
7.
Sun GE, Pantalone KM, Hatipoglu B. Hypothyroidism as a cause of hyponatremia: Fact or fiction? Endocr Pract 2012;18:894-7.  Back to cited text no. 7
    
8.
Nagata T, Nakajima S, Fujiya A, Sobajima H, Yamaguchi M. Prevalence of hypothyroidism in patients with hyponatremia: A retrospective cross-sectional study. PLoS One 2018;13:e0205687.  Back to cited text no. 8
    
9.
Baajafer FS, Hammami MM, Mohamed GE. Prevalence and severity of hyponatremia and hypercreatininemia in short-term uncomplicated hypothyroidism. J Endocrinol Invest 1999;22:35-9.  Back to cited text no. 9
    
10.
Agathis NT, Libman IM, Moritz ML. Hyponatremia due to severe primary hypothyroidism in an infant. Front Pediatr 2015;3:96.  Back to cited text no. 10
    
11.
Schutt-Aine JC. Hypothyroid myxedema and hyponatremia in an eight-year-old child: A case report. J Natl Med Assoc 1980;72:705-8.  Back to cited text no. 11
    
12.
Diker-Cohen T, Rozen-Zvi B, Yelin D, Akirov A, Robenshtok E, Gafter-Gvili A, et al. Endocrinopathy-induced euvolemic hyponatremia. Intern Emerg Med 2018;13:679-88.  Back to cited text no. 12
    
13.
Rahmani Tzvi-Ran I, Olchowski J, Fraenkel M, Bashiri A, Barski L. A rare cause of postpartum acute hyponatremia. Endocrinol Diabetes Metab Case Rep 2019;2019. pii: EDM180124.  Back to cited text no. 13
    
14.
Wehbe E, Grant ME. Severe hyponatremia and Schmidt's syndrome. Clin Exp Nephrol 2008;12:211-4.  Back to cited text no. 14
    




 

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