Association Between Blood Pressure, Glomerular Filtration Rate, and Serum Thyroid-Stimulating Hormone Levels in Hypothyroid Patients: A Retrospective Single-Center Study

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Abstract

Background: Thyroid hormones have substantial effects on blood pressure (BP) and renal function as they influence the glomerular filtration rate (GFR). Maintaining healthy BP and preventing premature development of nephropathy necessitates taking steps.

Objectives: The aim of this study was to explore the association between BP, GFR, and thyroid-stimulating hormone (TSH) levels in hypothyroid patients at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

Methods: A retrospective record review study of all hypothyroid patients from June 1, 2010 to June 6, 2020. The medical records of 1,181 adult patients were reviewed, and 157 met the criteria. All patients aged >18 years who were diagnosed with hypothyroidism and were on levothyroxine therapy, were included in this study.

Results: More than half of the participants were female (83.4%). There was no significant correlation between TSH and systolic BP (P= 0.6), or TSH and diastolic BP (P=0.8), while there was a positive correlation between TSH and creatinine (r=0.4, P=0.001) and a negative correlation between TSH and GFR (r=−0.2, P=0.01).

Conclusions: We found no association between BP and TSH, while creatinine correlated directly and GFR inversely with TSH. Follow-up renal function should be a target for physicians in hypothyroid patients to prevent premature complications.

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Most cited references 28

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A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group.

A S Levey, J Bosch, J. B. Lewis … (1999)

Serum creatinine concentration is widely used as an index of renal function, but this concentration is affected by factors other than glomerular filtration rate (GFR). To develop an equation to predict GFR from serum creatinine concentration and other factors. Cross-sectional study of GFR, creatinine clearance, serum creatinine concentration, and demographic and clinical characteristics in patients with chronic renal disease. 1628 patients enrolled in the baseline period of the Modification of Diet in Renal Disease (MDRD) Study, of whom 1070 were randomly selected as the training sample; the remaining 558 patients constituted the validation sample. The prediction equation was developed by stepwise regression applied to the training sample. The equation was then tested and compared with other prediction equations in the validation sample. To simplify prediction of GFR, the equation included only demographic and serum variables. Independent factors associated with a lower GFR included a higher serum creatinine concentration, older age, female sex, nonblack ethnicity, higher serum urea nitrogen levels, and lower serum albumin levels (P < 0.001 for all factors). The multiple regression model explained 90.3% of the variance in the logarithm of GFR in the validation sample. Measured creatinine clearance overestimated GFR by 19%, and creatinine clearance predicted by the Cockcroft-Gault formula overestimated GFR by 16%. After adjustment for this overestimation, the percentage of variance of the logarithm of GFR predicted by measured creatinine clearance or the Cockcroft-Gault formula was 86.6% and 84.2%, respectively. The equation developed from the MDRD Study provided a more accurate estimate of GFR in our study group than measured creatinine clearance or other commonly used equations.

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Prevalence of thyroid disease, thyroid dysfunction and thyroid peroxidase antibodies in a large, unselected population. The Health Study of Nord-Trondelag (HUNT).

O Krüger, K Hunstad, J Holmen … (2000)

To examine the prevalence of thyroid disease and dysfunction including thyroid autoimmunity in Norway. All inhabitants 20 years and older (94009) in Nord-Trondelag were invited to participate in a health survey with a questionnaire and blood samples. The prevalence of former diagnosed hyperthyroidism was 2.5% in females and 0.6% in males, hypothyroidism 4.8% and 0.9%, and goitre 2.9% and 0.4% respectively. In both sexes the prevalence increased with age. In individuals without a history of thyroid disease the median, 2.5 and 97.5 percentiles for TSH (mU/l) were 1.80 and 0.49-5.70 for females and 1. 50 and 0.56-4.60 for males. The TSH values increased with age. When excluding individuals with positive thyroid peroxidase antibodies (TPOAb) (>200U/ml), the 97.5 percentiles dropped to 3.60 mU/l and 3. 40 mU/l respectively. The prevalence of pathological TSH values in females and males were TSH >/=10mU/l 0.90% and 0.37%; TSH 4.1-9. 9mU/l 5.1% and 3.7%; and TSH 200U/ml) was 13.9% in females and 2.8% in males. In females the lowest percentage (7.9%) of positive TPOAb was seen with TSH 0.2-1.9mU/l and increased both with lower and higher levels of TSH. The percentage of males with positive TPOAb was lower than in females in all TSH groups except for those with TSH>10mU/l (85% TPOAb positive). In spite of a high prevalence of recognised thyroid disease in the population a considerable number of inhabitants have undiagnosed thyroid dysfunction and also positive TPOAb.

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The renal manifestations of thyroid disease.

Christopher Mariani, Els M. J. J. Berns (2011)

Thyroid hormones influence renal development, kidney structure, renal hemodynamics, GFR, the function of many transport systems along the nephron, and sodium and water homeostasis. These effects of thyroid hormone are in part due to direct renal actions and in part are mediated by cardiovascular and systemic hemodynamic effects that influence kidney function. As a consequence, both hypothyroidism and hyperthyroidism associate with clinically important alterations in kidney function and have relevance to its assessment. Disorders of thyroid function have also been linked to development of immune-mediated glomerular injury, and alterations in thyroid hormones and thyroid hormone testing occur in patients with kidney disease.

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Author and article information

Journal

Journal ID (nlm-ta): Cureus

Journal ID (iso-abbrev): Cureus

Journal ID (issn): 2168-8184

Title: Cureus

Publisher: Cureus (Palo Alto (CA) )

ISSN (Electronic): 2168-8184

Publication date (Electronic, pub): 2 September 2022

Publication date (Electronic, collection): September 2022

Volume: 14

Issue: 9

Electronic Location Identifier: e28686

Affiliations

[1 ] College of Medicine, King Abdulaziz University, Jeddah, SAU

[2 ] Endocrinology, King Abdulaziz University Hospital, Jeddah, SAU

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Manal O. Alsulami manal.alsulami@ 123456hotmail.com

Article

DOI: 10.7759/cureus.28686

PMC ID: 9526801

PubMed ID: 36199656

SO-VID: 6fbfea43-7dba-410c-a66e-4afec42f8569

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Association Between Blood Pressure, Glomerular Filtration Rate, and Serum Thyroid-Stimulating Hormone Levels in Hypothyroid Patients: A Retrospective Single-Center Study

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Most cited references 28

A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group.

Prevalence of thyroid disease, thyroid dysfunction and thyroid peroxidase antibodies in a large, unselected population. The Health Study of Nord-Trondelag (HUNT).

The renal manifestations of thyroid disease.

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