Serum Thyroxine and Thyroxine-Binding Proteins in Chronic Renal Failure Without Nephrosis

Neuhaus, Konstantin; Baumann, Gerhard; Walser, A.; Thölen, H.

doi:10.1210/jcem-41-2-395

Cited by 29 publications

(19 citation statements)

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“…We found that serum TT4 concentrations, although within the normal range, tended to be lower than in controls, in agreement with the findings of other investigators (5,14,33,46). Neuhaus et al (46) attributed the low TT4 to decreased serum albumin and prealbumin.…”

Section: Discussionsupporting

confidence: 93%

“…After TRH injection, serum TSH concentration rose rapidly in seven normal subjects, reached a peak by 30 min, and returned to basal levels in 3 h. Of the seven HD patients tested, one showed no increase in serum TSH concentration, four had a blunted response, and the other two showed a low normal response. In the latter, the peak was delayed until [45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] min, and TSH levels remained elevated for more than 3 h (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

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Thyroid Dysfunction in Chronic Renal Failure

Lim¹,

Fang²,

Katz³

et al. 1977

J. Clin. Invest.

219

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A B S T R A C T Thyroid function was evaluated in 46patients with end-stage kidney disease and 42 normal subjects. Patients were studied before and after the institution of maintenance hemodialysis (HD) and after renal transplantation (RT). Serum total triiodothyronine concentrations (TT3, ng/100 ml, mean± SD) were 63±17 and 83±22 in the non-HD and HD groups, respectively. Values from normal subjects were 128±25 and from RT patients 134±20. The TT3 was in the hypothyroid range (<78 ng/100 ml; 2 SD below normal mean) in 80% of non-HD and 43% of HD patients. Mean serum total thyroxine concentration (TT4), although within the normal range, was lower than the control value. T4-binding globulin capacity was also slightly lower but the difference was not statistically significant. Among patients whose TT4 was 1 SD below the normal mean, the free T4 index was equally depressed, suggesting that factors other than decreased binding capacity might be responsible for the low TT4. In addition, there was a 37% incidence of goiter. Mean serum thyroid-stimulating hormone (TSH) was not elevated and the TSH response to thyrotropinreleasing hormone (TRH) was distinctly blunted, suggesting the possibility of pituitary dysfunction as well. In vivo '25I-L-T4 and 13'I-L-T3 kinetics during 0.2 mg/day of L-T4 replacement showed marked reduction in T3 turnover rate in the uremic patients, both before and during HD; the values (,tg T3/day, mean±SD) for the different groups were as follows: normal, 33.8+6.1; non-HD, 13.5±2.6; HD, 12.9±3.1; and RT, 30.3±7.1.The low T3 turnover rate was due to impaired extrathyroidal conversion of T4 to T3. The mean perThis work was presented in part at the 50th Annual

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Section: Discussionsupporting

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Thyroid Dysfunction in Chronic Renal Failure

Lim¹,

Fang²,

Katz³

et al. 1977

J. Clin. Invest.

219

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“…The decreased levels of T4 may be secondary to the protein loss, which occur in CRF. Serum albumin and thyroid binding pre-albumin decreases 17 . Decrease in T4 is also attributed to the presence of circulating inhibitors, which impairs binding of T4 to thyroxine binding globulin.…”

Section: Discussionmentioning

confidence: 96%

“…The findings are comparable with previous study. 14,15,16,17 . The different studies mentioned various reasons to decreased levels of T4.…”

Section: Discussionmentioning

confidence: 99%

“…Hypothyroidism in CRF is mainly due to decreased level of albumin & thyroid binding prealbumin. 3 In CRF Circulating thyroid binding inhibitors are increased, which inhibits the binding of thyroid hormones to carrier proteins, it may be additional cause for hypothyroidism. 4 In CRF hypothyroidism is observed but still many patients are euthyroid with normal T3, T4 and TSH, the chances of developing hypothyroidism is increases as severity of the disease increases.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Study of Thyroid Abnormalities With Severity of Chronic Renal Failure

Shamsuddin¹,

Makandar²

2015

jemds

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BACKGROUND:Patients with CRF often have signs & symptoms suggestive of thyroid dysfunctions. Prevalence of hypothyroidism in patients with terminal renal failure is 5%, in comparison with that in hospitalized patients with normal renal function . CKD is associated with higher prevalence of hypothyroidism, both overt and subclinical, but not with hyperthyroidism. In fact, the prevalence of primary hypothyroidism is mainly in the subclinical form, which increases as GFR decreases. OBJECTIVES: To estimate thyroid hormone levels i.e. T3, T4 & TSH in CRF. To estimate Serum urea & creatinine for selection and categorizing the study subjects in to different grades of CRF. To study the thyroid hormone levels and thyroid abnormalities as the severity of CRF increases. MATERIALS AND METHODS:In this study 30 male patients of aged between 40-70yrs. with serum creatinine >5.5mg/dl & urea >55mg/dl and dipstick test positive for protein with symptoms of chronic renal failure are taken as cases. Age and sex matched normal healthy individuals are taken as controls. Serum Urea Estimated by DAM Method, serum creatinine is estimated by Jaffe's method and Serum levels of T3, T4 & TSH were analysed by using CLIA method. Results: T3, T4 decreases and TSH increases significantly in cases compare to the controls as the severity of dieses increases. In our study 10% of patients of CRF are hypothyroid and all these hypothyroid patients belongs to serum creatinine above 6 mg/dl category. CONCLUSION: Mean of T3, T4 decreases TSH increases significantly in cases compare to controls as the severity of CRF increases. The risk of hypothyroidism in chronic renal failure is very high if serum creatinine level are above 6 mg/dl.

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