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      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

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          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 (TT<sub>4</sub>), total triiodothyronine (TT<sub>3</sub>), reverse (rT<sub>3</sub>), and free T<sub>4</sub> (fT<sub>4</sub>) mean levels and normal TSH, free T<sub>3</sub>, TBG and albumin concentrations was found in both HD and CAPD patients. A ‘low-T<sub>4</sub> syndrome’ (serum T<sub>4</sub> < 5 μg/dl) was found in 9 CAPD (25%) and 20 HD (53%) patients, but none of them had fT<sub>4</sub> levels below the normal laboratory range. The only striking difference between low-T<sub>4</sub> HD and low-T<sub>4</sub> CAPD patients was the significantly lower TBG and albumin serum levels in CAPD group. Low-T<sub>4</sub> HD displayed normal TBG levels but enhanced fT<sub>4</sub>/TT<sub>4</sub> and TT<sub>4</sub>/TT<sub>4</sub> × 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-T<sub>4</sub> 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 fT<sub>4</sub> percentage despite normal TBG levels suggests either the presence of T<sub>4</sub>-TBG-binding inhibitor (s), or structural abnormalities of thyroid-hormone-binding proteins.

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          Author and article information

          S. Karger AG
          05 December 2008
          : 46
          : 3
          : 225-230
          Istituto di Clinica Medical dell’Università di Perugia, Servizi di aNefrologia e di bMedicina Nucleare dell’Ospedale Regionale, Perugia, Italia
          184359 Nephron 1987;46:225–230
          © 1987 S. Karger AG, Basel

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          Pages: 6
          Original Paper


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