Thyroid Function Tests in Patients Undergoing Maintenance Dialysis: Characterization of the ^‘Low-T ₄ Syndrome’ in Subjects on Regular Hemodialysis and Continuous Ambulatory Peritoneal Dialysis

Abstract

Thyroid function tests were evaluated in 38 patients on regular hemodialysis (HD), in 36 on continuous ambulatory peritoneal dialysis (CAPD) and in 39 healthy controls. A significant reduction in total thyroxine (TT₄), total triiodothyronine (TT₃), reverse (rT₃), and free T₄ (fT₄) mean levels and normal TSH, free T₃, TBG and albumin concentrations was found in both HD and CAPD patients. A ‘low-T₄ syndrome’ (serum T₄ < 5 μg/dl) was found in 9 CAPD (25%) and 20 HD (53%) patients, but none of them had fT₄ levels below the normal laboratory range. The only striking difference between low-T₄ HD and low-T₄ CAPD patients was the significantly lower TBG and albumin serum levels in CAPD group. Low-T₄ HD displayed normal TBG levels but enhanced fT₄/TT₄ and TT₄/TT₄ × TBG ratios. We concluded that: (1) the abnormalities in thyroid function tests in patients on long-term dialysis (HD and CAPD) do not express the existence of a true hypothyroidism; (2) a different pathogenesis of the low-T₄ syndrome in the CAPD and HD groups may be hypothesized: in the former it could be attributed to a reduction in serum-binding capacity for thyroid hormones, in the latter the relative increase in fT₄ percentage despite normal TBG levels suggests either the presence of T₄-TBG-binding inhibitor (s), or structural abnormalities of thyroid-hormone-binding proteins.