High prevalence of subclinical hypothyroidism and nodular thyroid disease in patients on hemodialysis

Abstract

Chronic kidney disease has been known to affect thyroid hormone metabolism. Low serum levels of T3 and T4 are the most remarkable laboratorial findings. A high incidence of goiter and nodules on thyroid ultrasonography has been reported in patients with end-stage renal disease (ESRD). Our objective is to evaluate the prevalence of laboratorial and morphologic alterations in the thyroid gland in a cohort of patients with ESRD on hemodialysis (HD). Sixty-one patients with ESRD on HD were selected and compared with 43 healthy subjects matched by age, gender, and weight. Patients were submitted to thyroid ultrasonography. T3, free T4 (FT4), thyroid-stimulating hormone, antithyroglobulin, and antithyroperoxidase antibodies were measured. The mean age of patients with ESRD was 47.4 ± 12.3 and 61% were women. ESRD was mainly caused by hypertensive nephrosclerosis and diabetic nephropathy. Mean thyroid volume, as determined by ultrasonography, was similar in both groups. Patients with ESRD had more hypoechoic nodules when compared with the control group (24.1% vs. 7.9%, P = 0.056). Mean serum FT4 and T3 levels were significantly lower in patients with ESRD, and subclinical hypothyroidism was more prevalent in patients with ESRD (21.82% vs. 7.14% control group, P = 0.04). Titers of antithyroid antibodies were similar in both groups. ESRD was associated with a higher prevalence of subclinical hypothyroidism and lower levels of T3 and FT4. Almost a quarter of patients showed thyroid nodules >10 mm. Periodic ultrasound evaluation and assessment of thyroid function are recommended in patients with ESRD on HD.

Sonographic assessment of thyroid gland in patients with chronic kidney disease undergoing hemodialysis

“…This result agreed with Ana et al who reported the prevalence of thyroid disorders was higher in female than male. [16] The current study revealed that the incidence of thyroid goiter was 21.57% in patients with CKD, which is approximately higher than previous studies. This finding agreed with Mohamed et al, who reported: "increased prevalence of thyroid goiter (0%-9%) in patients with CKD".…”

Prevalence of hypothyroidism and thyroid nodule in chronic hemodialysis Iranian patients

“…We found that HD patients had a significantly higher frequency of reduced FT3 (40.9% vs. 4.6%) and increased TSH (18.6% vs. 8.1%). In Costa's study, the serum FT4 and T3 levels were significantly lower in patients with ESRD, and subclinical hypothyroidism was more prevalent in patients with ESRD (21.82% vs. 7.14% in the control group) . Lin et al observed that hypothyroidism was significantly more frequent in uremic patients than in the control group (5.4% vs. 0.7%) .…”

“…Kutlay et al detected nodular goiter in 36.8% of the ESRD patients and 17.1% of the control groups . Da Costa et al's study demonstrated a clear tendency for HD patients to present with more thyroid nodules compared to control group (24.1% vs. 7.9%); the difference was not statistically significant . Patients with uremia have an increased thyroid volume compared with people with normal renal function and a higher incidence of goiter .…”

“…The prevalence of hypothyroidism in hemodialysis (HD) patients in previous studies was variable. In a study, prevalence of subclinical hypothyroidism in HD patients was 21.8% compared with 7.14% in the control group . In another study, the prevalence of hypothyroidism (TSH> 5 mU/L) in ESRD was 2.6% versus 1.1% in the control groups .…”

Functional Abnormalities and Thyroid Nodules in Patients with End-stage Renal Disease

“…These changes may result from functional abnormalities or neoplasm. In patients with ESRD, benign and malign nodules are more common than in the general population (20)(21)(22).…”