Hypothyroidism with elevated pancreatic amylase and lipase without clinical symptoms: A case report

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