Hyperkalemia Develops in Some Thyroidectomized Patients Undergoing Thyroid Hormone Withdrawal in Preparation for Radioactive Iodine Ablation for Thyroid Carcinoma |
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| Institution: | 1. From the Department of Endocrinology and Metabolism, Nagasaki, Japan.;2. Takashi Nagai Memorial International Hibakusha Medical Center, Nagasaki University Hospital, Nagasaki, Japan.;1. From the Chair; Chairman, Grunberger Diabetes Institute; Clinical Professor, Internal Medicine and Molecular Medicine & Genetics, Wayne State University School of Medicine; Professor, Medicine, Oakland University William Beaumont School of Medicince.;2. Director, AMCR Institute; Clinical Associate Professor, USCD School of Medicine.;3. Professor of Medicine, Loyola University Medical Center; Director, Loyola University Osteoporosis and Metabolic Bone Disease Center, Maywood, IL.;4. Immediate Past President, American College of Endocrinology; Past President, American Association of Clinical Endocrinologists; Medical Director, Scripps Whittier Diabetes Institute; Clinical Professor of Medicine, University of California, San Diego; Associate Editor, Journal of Diabetes; President, Diabetes and Endocrine Associates, La Jolla, CA.;5. Professor, Departments of Medicine, Biochemistry, Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX.;6. Medical Director & Principal Investigator, Metabolic Institute of America; President Elect, American College of Endocrinology.;7. Clinical Assistant Professor, Nova Southeastern University School of Osteopathic Medicine, Davie, FL.;8. Clinical Professor of Medicine, George Washington University, Alexandria, VA.;9. Professor of Medicine, Chief, Section of Endocrinology, Univeristy of Tennessee Graduate School of Medicine of Knoxville; Past President, American Association of Clinical Endocrinologists; Past President, American College of Endocrinology.;10. Managing Partner, North Texas Endocrine Center, Dallas, TX.;11. Endocrinology Associates, Houston, TX.;1. From the Division of Surgical Oncology and Endocrine Surgery, Vanderbilt University, Nashville, Tennessee;2. Department of Medicine, Stanford University, Palo Alto, California;3. Department of Medicine, Eastern Virginia Medical School, Norfolk, Virginia;4. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York;5. Department of Otolaryngology, Massachusetts General Hospital, Boston, Massachusetts. |
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| Abstract: | Objective: Hyponatremia is observed in hypothyroidism, but it is not known if hypo- or hyperkalemia is associated with hypothyroidism. To study these questions, we determined serum potassium (K+) levels in thyroidectomized patients undergoing levothyroxine withdrawal before radioactive iodine (RAI) therapy for thyroid carcinoma.Methods: We retrospectively studied the records of 108 patients who had undergone total thyroidectomy for thyroid carcinoma followed by levothyroxine withdrawal and then ablation with RAI at Nagasaki University Hospital from 2009–2013. Blood samples were analyzed for serum K+ concentrations when patients were euthyroid just before levothyroxine withdrawal and hypothyroid 21 days after levothyroxine withdrawal. We determined the proportion of patients who developed hyperkalemia (K+ ≥5 mEq/L) and hypokalemia (K+ ≤3.5 mEq/L).Results: Five (4.6%) patients developed hyperkalemia and 2 (1.9%) patients developed hypokalemia after levothyroxine withdrawal. The mean serum K+ level after levothyroxine withdrawal was significantly higher than before levothyroxine withdrawal (4.23 ± 0.50 mEq/L vs. 4.09 ± 0.34 mEq/L; P<.001). After levothyroxine withdrawal, serum K+ values were significantly correlated with age, serum sodium and creatinine levels, and the estimated glomerular filtration rate but not with serum free thyroxine or thyroid-stimulating hormone concentrations. The finding of an elevated serum K+ of >0.5 mEq/L after levothyroxine withdrawal was more prevalent with age >60 years (odds ratio OR], 4.66; P = .026) and with the use of angiotensin-II receptor blockers or angiotensin-converting enzyme inhibitors (OR, 3.53; P = .033) in a multivariate analysis.Conclusion: Hyperkalemia develops in a small percentage of hypothyroid patients after thyroid hormone withdrawal, especially in patients over 60 years of age who are using antihypertensive agents that inhibit the reninangiotensin- aldosterone system.Abbreviations: ACE-I = angiotensin-converting enzyme inhibitor ARB = angiotensin-II receptor blocker Cr = creatinine eGFR = estimated glomerular filtration rate Eu-K+ = serum level of K+ in the euthyroid state Hypo-K+ = serum level of K+ in the hypothyroid state K+ = potassium Na+ = sodium ?K+ = Hypo-K+ value minus Eu-K+ value RAI = radioactive iodine TSH = thyroid-stimulating hormone |
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