Association of Reduced Free T3 to Free T4 Ratio with Lower Serum Creatinine in Japanese Hemodialysis Patients

Abstract

Purpose: Low T3 syndrome is defined by a fall in free triiodothyronine (FT3) in spite of normal serum thyroid-stimulating hormone (TSH) and often normal free thyroxin (FT4). A low FT3/FT4 ratio, a relevant marker for low T3 syndrome, is known as a risk of mortality in hemodialysis (HD) patients, as well as low muscle mass in the general population. Because of the local activation of T4 to FT3 in muscle tissue, we examined the association of FT3/FT4 ratio with serum creatinine, a marker of muscle mass and strength in HD patients to investigate the significance of muscle tissue in the development of low T3 syndrome in HD patients. Methods: This was a cross-sectional study derived from our prospective cohort study, named DREAM, of Japanese HD patients. After the exclusion of patients with treated and untreated thyroid dysfunction, 332 patients were analyzed in the study. Results: The serum FT4 and TSH of HD patients (n = 332) were 0.9 ± 0.1 ng/dL. and 2.0 ± 0.9 μIU/mL, which were within the respective normal range, while serum FT3 was 2.2 ± 0.3 pg/mL. As many as 101 out of 332 (30.4%) HD patients exhibited a serum FT3 less than the normal lower limit of 2.2 pg/mL. The serum FT3/FT4 ratio correlated significantly positively with serum creatinine, and inversely with serum log CRP and total cholesterol, while it exhibited a tendency towards positive correlation with serum albumin. Multiple regression analysis, which included serum creatinine, albumin, and log CRP, simultaneously, in addition to sex, age, diabetic kidney disease or not, log HD duration, body mass index, systolic blood pressure, and Kt/V, as independent variables, revealed an independent and significant positive association of serum creatinine, but not serum albumin or CRP, with the serum FT3/FT4 ratio. Conclusions: The present study demonstrated an independent and positive correlation of serum creatinine with the serum FT3/FT4 ratio in HD patients. The lack of association of the serum FT3/FT4 ratio with serum albumin and CRP suggested the presence of a creatinine-specific mechanism to associate with serum FT3/FT4 ratio. Because of the local activation of T4 to T3 at muscle tissue, a lower muscle mass may be causatively associated with low T3 syndrome.

Evaluation the serum levels of T3, T4, TSH, Thyroglobulin and Galactin-3 in patients with benign and malignant thyroid tumors

“…The results in the table (9) exhibited a significant rises (p 0.05) of T3 and T4 concentration in patients with benign thyroid tumor, in BMI group (18-24.9) Kg/m2 matched with BMI groups (25-29.9) Kg/m2 and BMI groups (30-39.9) Kg/m2. Numerous studies have pronounced the association between BMI and levels of thyroid hormones, and the were diverse, one study exhibited that BMI was positively correlated to serum TSH and negatively to serum free T4 (FT4) and had no correlation to serum free T3(FT3) [25] lesser FT4 concentration were accompanied by elevated BMI values, but no association between BMI and FT3 was establish [26]. Serum FT4 (not TSH) was establish to have a negative correlation with BMI.…”

“…) presented a significant decline (p 0.05) of Galectin-3 in patients with malignant thyroid tumor later thyroidectomy matched with that earlier thyroidectomy.The results in table (3) exposed an insignificant deference (p 0.05) of Galectin-3 in patients with benign thyroid tumor earlier thyroidectomy as linked with that later thyroidectomy. We suggest that Galectin-3 is released from cancerous tissue, but when cancer tissue removed so there was no tissue to produce this high amount of Galectin-3.The results in the table (4) exhibited an insignificant rise (p>0.05) of Galectin-3 in patients with malignant thyroid tumor in age group(40)(41)(42)(43)(44)(45)(46)(47)(48)(49) years and age group (50 ) years compared with age group(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) years. Results in the table(5) exposed that there was insignificant rise (p>0.05) of Galectin-3 in patients with benign thyroid tumor in age group (40-49) years compared with age group (50 ) years and age group…”

“…The outcomes in the table (4) refers to that there was significant rises (P 0.05) of Tg in patients with malignant thyroid tumor in age group (40-49) years and age group (50 ) years matched with age group (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) years. One study indicated that established correlated reference values for age that rise Tg level exceeding the 40 years old [43], in addition to in patients underneath the age of 20 and beyond 60 years [44].…”

“…Definite study specified that galectin-3 was expressed in a great percentage of multinodular goiters, Hashimoto's thyroiditis and follicular adenomas [63]. (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) years. This results is explained because the illness age was generally in 40~50 years old [64].…”

The serum free triiodothyronine to free thyroxine ratio as a potential prognostic biomarker of chronic kidney disease in patients with glomerular crescents: A retrospective study

“…This process occurs mainly in the skeletal muscle ( 23 ). The rate of T4 to T3 de-iodination is represented by the serum FT3/FT4 ratio ( 24 , 25 ), which is positively associated with muscle mass in aged, obese, and HD individuals ( 24 – 26 ); a lower ratio indicates impaired physical performance. Moreover, recent evidences suggest that a low FT3/FT4 ratio may be related to unfavourable prognosis in specific clinical settings.…”