Distal Renal Tubular Acidosis can be the Cause of Hypokalemia in Graves’ Disease: A Rare Association

Year 2023, Volume: 5 Issue: 2, 423 - 5, 15.05.2023

Ismail Dundar , Ayşehan Akıncı , Emine Çamtosun , Nurdan Çiftci , Leman Kayaş

https://doi.org/10.37990/medr.1180665

Abstract

Distal renal tubular acidosis (dRTA) may rarely occur in the course of autoimmune diseases. We present a patient who was followed up with Graves' disease and vitiligo and who was diagnosed with dRTA upon detection of hypopotasemia. A 9.2-year-old girl presented with complaints of sweating, palpitations, and hand tremors. The patient had vitiligo on examination and was diagnosed with Graves' disease per clinical and laboratory findings. The patient, who received methimazole and was followed up as a euthyroid, was found to have hypokalemia in biochemical examinations performed at the age of 13 years. While investigating the etiology of hypokalemia, the patient was diagnosed with dRTA. Since she had two autoimmune pathologies, it was thought that the dRTA might be of autoimmune origin. Checking serum potassium levels in the follow-up of patients with Graves' disease may allow early diagnosis and treatment of accompanying dRTA.

Keywords

Distal renal tubular acidosis, Graves, vitiligo, autoimmune disorder

References

• 1. Sharma, S., Gupta, A. & Saxena, S. Comprehensive clinical approach to renal tubular acidosis. Clin. Exp. Nephrol. 19, 556–561 (2015).
• 2. Soares SBM, de Menezes Silva LAW, de Carvalho Mrad FC, Simões E Silva AC. World J Pediatr. 2019;15:422–31.
• 3. SORIANO, Juan Rodríguez. Renal tubular acidosis: the clinical entity. J. Am. Soc. Nephrol., 2002, 13.8: 2160-2170.
• 4. Both, T., Zietse, R., Hoorn, E. J., et al. Everything you need to know about distal renal tubular acidosis in autoimmune disease. Rheumatol. Int., 2014, 34.8: 1037-1045.
• 5. Hwang JW, Han KH, Kim YD, Hong HI, Shim MS, Kim JY. A case of renal tubular acidosis associated with Graves' disease. Korean J Intern Med. 2005;69(3):915-8.
• 6. Guerra-Hernández NE, Ordaz-López KV, Vargas-Poussou R, Escobar-Pérez L, García-Nieto VM. Distal renal tubular acidosis in two children with acquired hypothyroidism. Nefrologia. 2018 Nov-Dec;38(6):655-659
• 7. Roh JG, Park KJ, Lee HS, Hwang JS. Thyrotoxic hypokalemic periodic paralysis due to Graves’ disease in 2 adolescents. Ann Pediatr Endocrinol Metab. 2019 Jun;24(2):133.
• 8. Huth EJ, Mayock RL, Kerr RM. Hyperthyroidism associated with renal tubular acidosis: Discussion of possible relationship. Am. J. Med. 1959 May 1;26(5):818-26
• 9. Wu MS, Hong JJ. Concurrent gradient defect renal tubular acidosis and autoimmune lymphocytic thyroiditis. Nephrol Dial Transplant 1995;10:2122-3.
• 10. Dash SC, Jain S, Khanna KN, Grewal KS. Thyrotoxicosis, renal tubular acidosis and renal stone. J Assoc Physicians India 1980;28:323-5.