Abstract

Chronic Kidney Disease is a worldwide health problem with an increasing incidence and prevalence.  Abnormalities in the structure and function of the thyroid gland and in the metabolism and plasma concentration of thyroid hormones are common in patients with Chronic Kidney Disease.  In view of variability of thyroid function tests in patients with CKD in previous studies, a prospective study of various thyroid functions is undertaken to establish a correlation if any between thyroid dysfunction and severity of renal diseases.

Method: A prospective study was conducted on 50 patients with Chronic Kidney Disease on conservative management. Quantitative determination of T₃, T₄, TSH was done by Enzyme Linked Immunosorbent Assay and data were analyzed. 

Results: 24 patients had low T3 syndrome (0.2-1.9ng/ml, mean 0.665) which accounts for 48% of the patients, 11 patients had low T4 syndrome (0.5-9.5µg/ml, mean 5.631) which accounts for 22% of the patients and 5 patients had primary hypothyroidism TSH >20µIU/ml. Excluding Primary Hypothyroidism, analysis of serum T3,T4 and TSH in the study subjects shows very high significance χ2  = 20.82, p < 0.001. Distribution of Thyroid Dysfunction in this study among various creatinine clearance levels showed that as glomerular filtration rate declines, number of patients with low T3 syndrome increased χ2 = 8.47, p < 0.05, significant difference. In patients with low T3 syndrome, the mean values of TSH in various stages of renal disease are within normal range mean 4.85, values of TSH did not show any linear correlation with GFR. Number of patients with low T4 syndrome did not correlate with severity of renal disease. Thyroid Dysfunction occurred in 58% of the patients with chronic kidney disease in our study.

Conclusion: Thyroid dysfunction does not indicate a state of hypothyroidism, but a reflection of the state of chronic illness/malnutrition. The low T3 state of CKD can be viewed as being protective, promoting conservation of protein. The number of patients with low T3 syndrome progressively increases with the severity of renal failure.

1.      Andrew S. Levey, Josef Coresh, Ethan Balk, Annamaria T. Kausz, Ronald D. Perrone. National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratifiction. MD Ann Intern Med. 2003;139:137-147.

2.      Joanne M.Bargman, Karl S.Korecki. Chronic kidney disease. In: Dan L.Lango, Anthony S.Fauci, Dennis Kasper et al. Harrison’s Principles of Internal Medicine, Vol. 2, 18th edn., 2011; McGraw Hill, USA, pp. 2289-2293; 2308-2313.

3.      Feinstein EI, Kaptein EM, Nicoloff JT &Massry SG. Thyroid function in patients with nephrotic syndrome and normal renal function. American Journal of Nephrology 1982 2 70-76.

4.      Kaptein EM, Quion-Verde H &Massry SG. Hemodynamic effects of thyroid hormone. Contributions to Nephrology 1984 41 151-159.

5.      Kaptein EM. Thyroid function in renal failure. Contributions to Nephrology 1986 50 64-72.

6.      Robert W Schrier. Abnormalities in the thyroid gland and hypothalamo pituitary thyroid axis in patients with CKD – Diseases of the kidney and urinary tract, eighth edition 2007; volume 3: page number 2518

7.      Feinstein EI, Kaptein EM, Nicoloff JT & Massry SG. Thyroid function in patients with nephrotic syndrome and normal renal function. American Journal of Nephrology 1982 2 70–76.

8.      Kaptein EM, Quion-Verde H & Massry SG. Hemodynamic effects of thyroid hormone. Contributions to Nephrology 1984 41 151–159.

9.      Kaptein EM. Thyroid function in renal failure. Contributions to Nephrology 1986 50 64–72.

10.  Kaptein EM, Feinstein EI & Massry SG. Thyroid hormone metabolism in renal diseases. Contributions to Nephrology 1982 33 122–135.

11.  Kaptein EM, Quion-Verde H, Chooljian CJ, Tang WW, Friedman PE, Rodriquez HJ & Massry SG. The thyroid in endstage renal disease. Medicine 1988 67 187–197.

12.  Parameswaran S. Chronic kidney disease in India. Health Sci 2012;1:JS001

13.  Kaptein EM. Thyroid hormone metabolism and thyroid disease in chronic renal failure. Endocrin Rev 1996;17:4563.

14.  Ramirez G et al. Thyroid abnormalities in renal failure. A study of 53 patients on chronic dialysis. Ann Internal Medicine, 1973; 79, 500-4

15.  Kayima JK et al. Thyroid hormones profile in patients with chronic renal failure on conservative management and regular hemodialysis. East Afr Med J, 1992; 69: 333-6.

16.  Avasthi G et al. Study of Thyroid function in patients of chronic renal failure. Indian Journal of Nephrology, 2001; 11: 165-170.

17.  Spector DA et al. Thyroid function and metabolic rate in chronic renal failure. Ann Intern Med. 1976; 85: 724-30

18.  Quion-verde et al. Prevalence of thyroid disease in chronic renal failure and dialysis patients. IXt1’ mt Congr of Nephrol, 1984; 120