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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
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 (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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184359 Nephron 1987;46:225–230Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.