Clinical Analysis of Misdiagnosis of Primary Nephrotic Syndrome as Hypothyroidism

LI Nan; FENG Yonghao; SHI Xiaohong

doi:10.3969/j.issn.1002-3429.2025.11.004

Abstract：Objective To analyze the causes of misdiagnosis of primary nephrotic syndrome(PNS)as hypothyroidism,in order to improve the diagnosis and treatment.Methods A retrospective analysis was conducted on the clinical manifestations,laboratory and imaging data of 4 patients with primary nephrotic syndrome who were initially misdiagnosed as hypothyroidism and admitted from February 2022 to December 2023.Results Among the 4 patients,1 patient presented with facial and lower extremity edema and general weakness,1 patient with anorexia,constipation and shortness of breath after activity,1 patient with weakness and decreased appetite and 1 patient with thirst,weakness and edema of both lower extremities and face.The body weight increased in all patients,and the urine protein increased in all patients.Thyroid function tests showed decreased triiodothyronine and thyroxine in 4 patients,who also had elevated blood lipid levels,therefore,they were initially diagnosed with hypothyroidism.After symptomatic treatment,the condition did not improve.Afterwards,it was confirmed as PNS through renal biopsy.The misdiagnosis lasted 15 to 21 d.After diagnosis,Prednisone,Cyclophosphamide and/or Tacrolimus were administered.The edema subsided significantly,various test indicators improved,clinical symptoms improved,and no recurrence was observed during the 1-year follow-up.Conclusion When patients with PNS seek medical treatment due to complications,their primary diseases are often ignored by non-specialist physicians,resulting in misdiagnosis.Medical staff should enhance their professional knowledge level,standardize the diagnosis and treatment process,and attach greater importance to the pathological diagnosis of renal biopsy,so as to reduce the unnecessary medical burden and complication risk caused by misdiagnosis.