[Adult male with tubulointerstitial nephritis and uveitis syndrome complicated with thyroiditis].

ABSTRACT

Renal dysfunction was detected by routine medical examination in a 46-year-old man (blood urea nitrogen 26 mg/dL, creatinine 2.4 mg/dL and moderate proteinuria). A few weeks later, he visited a local ophthalmologist complaining of left eye pain and red eye. He was diagnosed as left uveitis, prescribed eye-drops and referred to our hospital for further examination. At the first visit, test results pointed to renal dysfunction and a high level of thyroid hormones (creatinine 1.8 mg/dL, free T3 7.41 microg/mL, free T4 3.18 ng/dL, thyroid stimulating hormone 0.010micro IU/mL). Gallium scintigraphy showed an increased uptake of the tracer in bilateral thyroid glands, parotid glands and kidneys. No autoantibodies to thyroid gland were detected. Ultrasonography of the thyroid gland revealed no abnormal findings. Renal biopsy showed interstitial nephritis with minor glomerular abnormalities except for a few sclerotic changes. As no improvement was observed after stopping all drugs, and no disease causing uveitis was detected, he was diagnosed as tubulointerstitial nephritis and uveitis syndrome (TINU syndrome). After oral glucocorticoid was prescribed (prednisolone 15 mg/day), both renal function and thyroid abnormalities were normalized gradually. TINU syndrome with hyperthyroidism is rare. Although the precise etiology is not known, the same mechanism might occur in the thyroid gland as in TINU syndrome where abnormal cellular immunity, especially in helper T cell is said to play a role. In conclusion, in cases of TINU syndrome, systemic investigation, including the thyroid gland should be mandatory.