Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2020; 8(15): 3299-3304
Published online Aug 6, 2020. doi: 10.12998/wjcc.v8.i15.3299
Hypothyroidism with elevated pancreatic amylase and lipase without clinical symptoms: A case report
Yong-Wei Xu, Ran Li, Shu-Chang Xu
Yong-Wei Xu, Shu-Chang Xu, Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
Ran Li, Department of Endocrinology and Metabolism, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
Author contributions: Xu YW drafted the manuscript; Xu YW and Li R analyzed the data; Xu SC revised the article critically; all authors read and approved the final manuscript.
Supported by Shanghai Shenkang Hospital Development Center, No. SHDC12016109.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shu-Chang Xu, PhD, MD, Chief Doctor, Professor, Department of Gastroenterology, Tongji Hospital, Tongji University School of Medicine, No. 389 Xincun Road, Putuo District, Shanghai 200065, China. xschang@163.com
Received: March 21, 2020
Peer-review started: March 21, 2020
First decision: April 24, 2020
Revised: April 30, 2020
Accepted: July 15, 2020
Article in press: July 15, 2020
Published online: August 6, 2020
Processing time: 124 Days and 8.2 Hours
Abstract
BACKGROUND

Hypothyroidism is an endocrine disorder that has worldwide prevalence and can affect multiple organ systems. We report a case of hypothyroidism with elevated pancreatic amylase and trypsin without acute pancreatitis. No such case has been previously reported.

CASE SUMMARY

A 29-year-old woman did not pay much attention to a fever 4 d prior. During this time, she experienced anorexia and only drank a small amount of water every day. She did not present with abdominal distension, postprandial nausea, vomiting, cough or expectoration. After physical and laboratory examinations, the patient was diagnosed with hypothyroidism. During the course of the disease, hypothyroidism was generally accompanied by constantly increased pancreatic amylase and trypsin. After admission, the possible etiology of the patient was excluded and the concentrations of pancreatic lipase and amylase in serum were > 2000U/L (reference range 23-300 U/L) and 410 U/L (reference range 30-110 U/L), respectively. So we highly suspected that it may be acute pancreatitis. Interestingly, she never developed any complications associated with acute pancreatitis despite high levels of serum pancreatic amylase and trypsin, and she reported no symptoms of abdominal pain. Serum amylase and lipase decreased gradually after active thyroxine supplementation, and the patient was discharged from the hospital after active treatment.

CONCLUSION

This case suggests that clinicians should pay attention to hypothyroidism with elevated pancreatic amylase and trypsin, even if no complications of acute pancreatitis are reported.

Keywords: Hypothyroidism; Amylase; Trypsin; Acute pancreatitis; Clinical symptoms; Case report

Core tip: Hypothyroidism is an endocrine disorder that has worldwide prevalence and can affect multiple organ systems. However, even when pancreatic amylase and lipase are elevated, hypothyroidism without acute pancreatitis rarely causes clinical symptoms. Here, we report a case of hypothyroidism leading to elevated trypsin without acute pancreatitis in a patient who had no clinical symptoms. This case report can serve as a reminder to gastroenterologists, emergency physicians, and surgeons who encounter these cases in clinical practice.