Severe Rhabdomyolysis in a Patient With Untreated Hypothyroidism Receiving Statin Therapy: A Case Report

Rhabdomyolysis is a potentially life-threatening condition characterized by skeletal muscle breakdown and may lead to acute kidney injury (AKI) and multiorgan dysfunction.We report the case of a 61-year-old woman with depressive disorder and dyslipidemia who was prescribed rosuvastatin and ezetimibe five months before admission.She presented to the emergency department with progressive myalgia and muscle weakness, ultimately resulting in an inability to walk.Laboratory evaluation revealed severe rhabdomyolysis, AKI, hyponatremia, hypocalcemia, and markedly elevated aminotransferases.Further etiologic investigation identified severe hypothyroidism secondary to autoimmune thyroiditis.Rosuvastatin and ezetimibe were discontinued, and levothyroxine replacement therapy was initiated.Because of hypervolemia and metabolic acidemia, continuous kidney replacement therapy (CKRT) was required.Given the markedly elevated myoglobin levels, hemoadsorption with an HA380 cartridge was also performed.Anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase antibodies were negative.Renal function progressively recovered, with complete resolution of rhabdomyolysis.This case underscores severe untreated hypothyroidism as an important predisposing factor for statin-associated muscle toxicity and supports consideration of thyroid function assessment in patients with suggestive symptoms or additional risk factors before or during statin therapy.Hemoadsorption may represent an adjunctive therapeutic option in selected patients with markedly elevated myoglobin levels; however, its contribution to renal recovery cannot be determined from a single case report.