Hypothyroidism and Nephrotic Syndrome: Why, When and How to Treat

Mario, Francesca Di; Pofi, Riccardo; Gigante, Antonietta; Rivoli, Laura; Rosato, Edoardo; Isidori, Andrea M.; Cianci, Rosario; Barbano, Biagio

doi:10.2174/1570161115999170207114706

Cited by 25 publications

(20 citation statements)

References 57 publications

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“…TD is common in patients with nephrotic syndrome (NS) [51]. All patients with nephrotic range proteinuria have increased urinary loss of TH and thyroid-binding globulin [52].…”

Section: Viscerometabolic Dysfunctionsmentioning

confidence: 99%

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Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Kalra

Aggarwal²,

Khandelwal

2021

International Journal of Endocrinology

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Thyroid dysfunction (TD) is common in metabolic disorders such as diabetes mellitus (DM), cardiovascular disease (CVD), obesity, dyslipidemia, hyperuricemia, kidney and liver dysfunctions, and polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SHypo) worsens glycemic control in patients with DM, and these patients, especially those with Type-1DM, have higher prevalence of TD. Both TD and DM increase CVD risk. Even minor alteration in thyroid hormone (TH) levels can alter cardiovascular function. While hyperthyroidism increases systolic blood pressure and leads to high-output heart failure, hypothyroidism increases diastolic blood pressure and leads to low-output heart failure. Chronic subclinical hyperthyroidism (SHyper) and SHypo both increase the risk of hypertension, coronary artery disease (CAD) events, CAD deaths, and total deaths. SHyper alters cardiac morphology and function. SHypo causes dyslipidemia and endothelial dysfunction and increases the risk for weight gain and obesity. Overweight and obese patients often have hyperleptinemia, which increases the secretion of thyroid stimulating hormone (TSH) and induces TD. Dyslipidemia associated with TD can increase serum uric acid levels. Hyperuricemia promotes inflammation and may increase the risk for dyslipidemia, atherosclerosis, and CVD. TD increases the risk for developing chronic kidney disease. In nephrotic syndrome, proteinuria is associated with urinary loss of TH leading to TD. Some correlation between TD and severity of liver disease is also seen. TD and PCOS have common risk factors and pathophysiological abnormalities. Hypothyroidism must be excluded before diagnosing PCOS. Current guidelines do not strongly recommend thyroid screening in the presence of all metabolic disorders. However, pragmatic thyrovigilance is required. Clinicians must stay alert to signs and symptoms of TD, maintain high clinical suspicion, and investigate thoroughly. Drug-induced TD should be considered when TH levels do not match clinical findings or when patients are on medications that can alter thyroid function.

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“…TD is common in patients with nephrotic syndrome (NS) [51]. All patients with nephrotic range proteinuria have increased urinary loss of TH and thyroid-binding globulin [52].…”

Section: Viscerometabolic Dysfunctionsmentioning

confidence: 99%

“…All patients with nephrotic range proteinuria have increased urinary loss of TH and thyroid-binding globulin [52]. With a normal thyroid reserve, this causes SHypo; with a low thyroid reserve, this leads to overt hypothyroidism [51]. It is essential to recognize and treat this TD with TH replacement.…”

Section: Viscerometabolic Dysfunctionsmentioning

confidence: 99%

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Kalra

Aggarwal²,

Khandelwal

2021

International Journal of Endocrinology

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“…5 In particular, nephrotic children with low thyroid reserves may develop subclinical hypothyroidism which, without thyroxine (T4) replacement therapy, will likely progress to overt hypothyroidism. 6 Hence, the need for T4 replacement therapy in patients with hypothyroidism is increased in the presence of nephrotic syndrome. 7 Thyroid hormonal therapy in children with subclinical hypothyroidism and short stature has been shown to improve growth velocity, especially in prepubertal groups, although other researchers have reported contradictory findings.…”

mentioning

confidence: 99%

Thyroid Dysfunction in Children with Idiopathic Nephrotic Syndrome Attending a Paediatric Hospital in Qazvin, Iran

Saffari

Ahadi

Dalirani

et al. 2020

Sultan Qaboos Univ Med J

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Objectives: Nephrotic syndrome is a glomerular disease characterised by a loss of albumin and high-molecular-weight proteins such as thyroxine-binding globulin and thyroid hormones, potentially resulting in subclinical or even overt hypothyroidism. This study aimed to compare thyroid hormone levels between nephrotic children and healthy controls as well as between nephrotic children in the active phase of the disease and those in remission. Methods: This case-control study was conducted between March 2016 and 2018 at a paediatric hospital in Qazvin, Iran. A total of 73 nephrotic children comprised the case group—including 49 with active disease and 24 in remission—while the control group included 74 healthy children. Thyroid function was assessed according to levels of thyroid-stimulating hormone (TSH), free triiodothyronine (T3), free thyroxine (T4), total T4, total T3 and anti-thyroid peroxidase. Results: All of the controls had normal total T4 levels. Elevated TSH levels were more frequent in nephrotic children compared to controls (34.2% versus 10.8%; P = 0.001). A significantly lower number of patients with active disease were euthyroid compared to those in remission (51% versus 95.8%; P = 0.001). Moreover, 7 (9.5%) of patients in the active and no patient in remission phase had abnormal total T4 levels (P <0.001), while 14.3% and 0% had highly elevated TSH levels (P = 0.002). Conclusion: Due to the prevalence of subclinical and even overt hypothyroidism, thyroid screening tests may be required for nephrotic children. However, further research is needed to confirm these findings. Keywords: Nephrotic Syndrome; Children; Albuminuria; Proteinuria; Hypothyroidism; Iran.

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“…If nephrotic syndrome is accompanied by hypothyroidism, this may affect water-electrolyte hemostasis and may exacerbate fluid retention, which may be difficult to resolve if the treatment of hypothyroidism is delayed. These patients have worse quality of life and poor prognosis 14 . This study may guide whether atypically presented NS children need thyroid replacement therapy or not.…”

Section: Impaired Renal Functionmentioning

confidence: 99%

Effect of Steroid Therapy on Thyroid Function Status in Typically and Atypically Presented Nephrotic Syndrome

Datta¹,

Quader²,

Haque³

et al. 2020

Chatt Maa Shi Hosp Med Coll J

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Background: Mild or subclinical hypothyroidism may coexist with NephroticSyndrome (NS). But persistence of this hypothyroidism is related with remission ofproteinuria. Objectives of the study is to compare thyroid function status (FT4 andTSH) in the atypical and typical NS before and 4 weeks after steroid therapy. Materials and methods: This was a hospital based comparative observational studywith prospective follow up of study subjects. It was carried out in the Department ofPediatrics and in the Department of Nephrology, Chattogram Medical CollegeHospital (CMCH) Chattogram, Bangladesh from January to December’ 2017. A total83 diagnosed admitted cases of initial attack idiopathic NS, aged 1-18 years ofeither sex divided into 2 groups were included. Typically presented NS were in groupA and atypically presented NS were in group B. FT4 and TSH were estimated in allpatients on 2 occasions before and 4 weeks after initiation of steroid therapy andcomparison was done between 2 groups. Results: FT4 level was normal before and after steroid therapy in both typically andatypically presented nephrotic syndrome. Before steroid therapy, mean TSH valuewas found significantly raised in both groups (9.28±5.17 vs 7.26±3.67 μIU/ml).Proportion of subclinical hypothyroidism was statistically similar. After treatmentwith steroid, number of subclinical hypothyroid cases reduced in both groups withreduction of TSH value (3.13±1.14 vs 5.38±2.52 μIU/ml). But significant difference inTSH value was observed in between two groups. There was persistence of subclinicalhypothyroidism after treatment with steroid among 16.6 % (14.2% grade II and2.3% grade I) children with atypically presented NS and which is statisticallysignificant (p=0.006). Conclusion: Subclinical hypothyroidism persists in atypically presented nephroticsyndrome even after treatment with steroid. Chatt Maa Shi Hosp Med Coll J; Vol.19 (1); January 2020; Page 28-32

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Hypothyroidism and Nephrotic Syndrome: Why, When and How to Treat

Abstract: In this article we summarise the evidence on this nephro-endocrine disorder in humans and focus on diagnostic and therapeutic strategies.

Cited by 25 publications

References 57 publications

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Thyroid Dysfunction in Children with Idiopathic Nephrotic Syndrome Attending a Paediatric Hospital in Qazvin, Iran

Effect of Steroid Therapy on Thyroid Function Status in Typically and Atypically Presented Nephrotic Syndrome

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