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      Functional Thyroid Disorders Are More Common in Patients on Chronic Hemodialysis Compared with the General Population

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          Abstract

          Introduction:

          Thyroid function disorders are common in patients with chronic kidney disease. The aim of this study was to compare thyroid function among patients on chronic hemodialysis (HD) and healthy participants and to assess duration of dialysis on thyroid disorders.

          Material and methods:

          Prospective study included 80 participants divided in two groups. Study group included 40 patients on HD who were divided in two subgroups, according to time on dialysis (under and over 72 months). Exclusion critheria were: previous thyroid disorders, systemic illnesses, criticaly ill patients and acute inflamatory diseases. Control group included 40 healthy participants. Blood samples were taken for standard laboratory analysis, total and free thyroid hormone levels.

          Results:

          In HD group we found statistycally significant lower mean values of T3 (1,36 ± 0.451, p<0.0001), T4 (80.33 ± 19.167, p= 0.0001), and higher mean values of TSH (3.16 ± 3.168, p= 0.01), higher frequency of low T3 syndrome in 12.5% (n=5) (p=0.01) and subclinical hypothyroidism in 17.5% (n=7) (p=0.021). In the subgroup of patients with time on HD <72 months, significantly, more frequent and low T3 syndrome was found in 19.23% (n = 5) (p = 0.01). In the subgroup of patients with HD >72 months subclinical hypothyroidism was found more frequently in 35.71% (n = 5) (p = 0.04).

          Conclusion:

          Thyroid disorders are more common in patients on HD compared to general population. These findings suggest that thyroid function and morphology screening should be performed in HD patients.

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          Most cited references19

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          The Colorado thyroid disease prevalence study.

          The prevalence of abnormal thyroid function in the United States and the significance of thyroid dysfunction remain controversial. Systemic effects of abnormal thyroid function have not been fully delineated, particularly in cases of mild thyroid failure. Also, the relationship between traditional hypothyroid symptoms and biochemical thyroid function is unclear. To determine the prevalence of abnormal thyroid function and the relationship between (1) abnormal thyroid function and lipid levels and (2) abnormal thyroid function and symptoms using modern and sensitive thyroid tests. Cross-sectional study. Participants in a statewide health fair in Colorado, 1995 (N = 25 862). Serum thyrotropin (thyroid-stimulating hormone [TSH]) and total thyroxine (T4) concentrations, serum lipid levels, and responses to a hypothyroid symptoms questionnaire. The prevalence of elevated TSH levels (normal range, 0.3-5.1 mIU/L) in this population was 9.5%, and the prevalence of decreased TSH levels was 2.2%. Forty percent of patients taking thyroid medications had abnormal TSH levels. Lipid levels increased in a graded fashion as thyroid function declined. Also, the mean total cholesterol and low-density lipoprotein cholesterol levels of subjects with TSH values between 5.1 and 10 mIU/L were significantly greater than the corresponding mean lipid levels in euthyroid subjects. Symptoms were reported more often in hypothyroid vs euthyroid individuals, but individual symptom sensitivities were low. The prevalence of abnormal biochemical thyroid function reported here is substantial and confirms previous reports in smaller populations. Among patients taking thyroid medication, only 60% were within the normal range of TSH. Modest elevations of TSH corresponded to changes in lipid levels that may affect cardiovascular health. Individual symptoms were not very sensitive, but patients who report multiple thyroid symptoms warrant serum thyroid testing. These results confirm that thyroid dysfunction is common, may often go undetected, and may be associated with adverse health outcomes that can be avoided by serum TSH measurement.
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            Thyroid dysfunction and kidney disease.

            Thyroid hormones (TH) are essential for an adequate growth and development of the kidney. Conversely, the kidney is not only an organ for metabolism and elimination of TH, but also a target organ of some of the iodothyronines' actions. Thyroid dysfunction causes remarkable changes in glomerular and tubular functions and electrolyte and water homeostasis. Hypothyroidism is accompanied by a decrease in glomerular filtration, hyponatremia, and an alteration of the ability for water excretion. Excessive levels of TH generate an increase in glomerular filtration rate and renal plasma flow. Renal disease, in turn, leads to significant changes in thyroid function. The association of different types of glomerulopathies with both hyper- and hypofunction of the thyroid has been reported. Less frequently, tubulointerstitial disease has been associated with functional thyroid disorders. Nephrotic syndrome is accompanied by changes in the concentrations of TH due primarily to loss of protein in the urine. Acute kidney injury and chronic kidney disease are accompanied by notable effects on the hypothalamus-pituitary-thyroid axis. The secretion of pituitary thyrotropin (TSH) is impaired in uremia. Contrary to other non-thyroidal chronic disease, in uraemic patients it is not unusual to observe the sick euthyroid syndrome with low serum triodothyronine (T(3)) without elevation of reverse T(3) (rT(3)). Some authors have reported associations between thyroid cancer and kidney tumors and each of these organs can develop metastases into the other. Finally, data from recent research suggest that TH, especially T(3), can be considered as a marker for survival in patients with kidney disease.
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              Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease.

              Previous studies have suggested a higher prevalence of thyroid abnormalities in persons with end-stage renal disease. However, little is known regarding the epidemiology of thyroid disorders in persons with less severe kidney dysfunction. We used data from the Third National Health and Nutrition Examination Survey to examine the prevalence of hypothyroidism (clinical and subclinical) at different levels of estimated glomerular filtration rate (GFR). We used multivariable logistic regression to evaluate the association between GFR and prevalent hypothyroidism. Among 14,623 adult participants with serum creatinine and thyroid function test results, the mean age was 48.7 years, and 52.6% were women. The prevalence of hypothyroidism increased with lower levels of GFR (in units of mL/min/1.73 m(2)), occurring in 5.4% of subjects with GFR >/=90, 10.9% with GFR 60-89, 20.4% with GFR 45-59, 23.0% with GFR 30-44, and 23.1% with GFR /=90 mL/min/1.73 m(2), reduced GFR was associated with an increased risk of hypothyroidism, after adjusting for age, gender, and race/ethnicity: adjusted odds ratio 1.07 (95% confidence interval: 0.86-1.32) for GFR 60-89, 1.57 (1.11-2.22) for GFR 45-59, 1.81 (1.04-3.16) for GFR 30-44, and 1.97 (0.69-5.61) for GFR <30 mL/min/1.73 m(2) (P= 0.008 for trend). Among a nationally representative sample of adults, reduced glomerular filtration rate was associated with a higher prevalence of hypothyroidism, with many subclinical cases. Future studies are needed to determine the potential adverse effects of subclinical and clinical hypothyroidism in persons with chronic kidney disease.
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                Author and article information

                Journal
                Mater Sociomed
                Mater Sociomed
                MSM
                Materia Socio-Medica
                AVICENA, d.o.o., Sarajevo
                1512-7680
                1986-597X
                2011
                : 23
                : 4
                : 206-209
                Affiliations
                [1 ]Department of Endocrinology, Clinic for Internal Diseases, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
                [2 ]Department of Nephrology and Dialysis, Clinic for Internal Diseases, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
                Author notes
                Corresponding author: Selma Jusufovic, MD. Department of Endocrinology, Clinic for Internal Diseases, UCC Tuzla, Trnovac bb, 75 000 Tuzla, B&H. E-mail: selma.jusufovic@ 123456gmail.com
                Article
                MSM-23-206
                10.5455/msm.2011.23.206-209
                4651319
                26664295
                8894ff3f-6fe5-41dd-80ce-eb17c6110b14
                © 2011 AVICENA

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 3 October 2011
                : 26 November 2011
                Categories
                Article

                thyroid function,hemodialysis,tsh,ckd.
                thyroid function, hemodialysis, tsh, ckd.

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