Non-autoimmune subclinical and overt hypothyroidism in idiopathic steroid-resistant nephrotic syndrome in children

Marimuthu, Vidhya; Krishnamurthy, Sriram; Rajappa, Medha

doi:10.1007/s13312-017-1183-2

Cited by 11 publications

(8 citation statements)

References 14 publications

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“…. But persistently higher TSH was observed in atypically presented NS children which was similar to the findings of Dagan A et al and Marimuthu V et al in SRNS children 21,22 . TSH value was 6.92±2.9µIU/ml and 4.55±4.64 µIU/ml respectively.…”

Section: Resultssupporting

confidence: 88%

“…In this study persistent subclinical hypothyroidism 4 weeks after steroid therapy was observed among 16.6% (4 were grade II and 3 were grade I) of atypically presented NS children. Sharma S et al, Kapoor K et al and Marimuthu V et al also observed subclinical hypothyroidism in SRNS children and the prevalence was 20%, 30% and 33.3% respectively 9,10,22 . But in this study only 14 atypically presented NS patients were steroid resistant.…”

Section: Resultsmentioning

confidence: 89%

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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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Section: Resultssupporting

confidence: 88%

Section: Resultsmentioning

confidence: 89%

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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“…15 Marimuthu V et al, conducted a cross-sectional study recruited 30 children (age 1-18 years) with idiopathic Steroid responsive nephrotic syndrome (SRNS) and 30 healthy controls. 16 To evaluate the frequency of nonautoimmune subclinical and overt hypothyroidism in children with idiopathic SRNS. Overt hypothyroidism was detected in 10 out of 30 children with idiopathic SRNS.…”

Section: Resultsmentioning

confidence: 99%

Thyroid function studies in children of nephrotic syndrome

Dhanjal

Garg

2019

Int J Contemp Pediatr

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Background: Nephrotic syndrome is a condition which is characterized by proteinuria, hypoproteinemia, hypercholesterolemia and significant edema. In children with nephrotic syndrome, it is probable to determine a hypothyroid state because of significant loss of thyroxine (T4), triiodothyronine (T3) in presence of proteinuria. The objectives of this study were to evaluate the level of serum free T3, free T4, and TSH in children with nephrotic syndrome and its correlation with healthy controls.Methods: A comparative study was carried out on total of 60 children (divided into two equal groups of 30 cases and 30 controls) in the age group of 1-18 years of either sex admitted to Department of Paediatrics. Maharishi Markandeshwar institute of Medical Sciences and Research. Mullana, Ambala, Haryana over a from January 2017 to September 2018. Serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH) were done in all 60 children and compared.Results: Among cases 18 (60%) were males and 12 (40%) were females. 63.4% of the cases were in the age group 1-10 years and 36.6% were in age group 11-18 years. Studied patients showed lowered FT3 and FT4 and raised TSH in comparison with normal values.Conclusions: Hypothyroidism should be actively sought for in children with nephrotic syndrome as it is a treatable complication.

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“…The findings of Saffari et al study underline the importance of conducting thyroid function tests in NS children with prolonged and severe urinary protein loss [ 4 ]. Almost one-third of children with idiopathic steroid resistant NS have overt or subclinical hypothyroidism [ 16 ]. Early diagnosis and treatment of thyroid hormone deficiency in children is critical for preserving normal linear growth and bone development [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Overt Hypothyroidism and Severe Growth Retardation in a Preschool Girl with Poorly Controlled Nephrotic Syndrome: Case Report and Literature Review

Mikulevič,

Tumelienė,

Kemežys

et al. 2023

AML

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Background. Nephrotic children may develop thyroid hormone dysfunction due to urinary excretion of thyroid hormones. In contrast to the subclinical hypothyroidism that affects around 30% of children with nephrotic syndrome (NS), the patient in this case had overt hypothyroidism and severe growth retardation.Clinical case. A 5 years and 8 months old girl with steroid-dependent NS was referred from another center due to persistent edema and decreased diuresis, being treated with mycophenolate mofetil (MMF) 250 mg once a day and L-thyroxine 50 mcg daily since 4 months of NS onset because of hypothyroidism. Her albumin was 12.64 g/l, cholesterol 25.64 mmol/l and proteinuria 5 g/l. Severe growth retardation was observed: patient’s height was 93.5 cm (–13 cm <3 percentile), weighted 17.2 kg (15–25 percentile). Her disease vintage was over 3 years. Girl’s growth velocity has slowed down from 3.5 months. The patient received a high cumulative dose of prednisolone (approx. 7800 mg in 1 year and 8 months). Thyroid-stimulating hormone was higher (18.04 mU/L) with reduced FT4 11.43 pmol/l and IGF-1 < 15 µg/L. Kidney biopsy revealed minimal change disease, and genetic testing was negative. Intensive NS treatment with methylprednisolone pulse therapy, enlarged doses of MMF and albumin infusion were started and L-thyroxine dose was increased to 75 mcg. TPOAb was in normal range (12.65 IU/ml). After 3 weeks she was discharged with no edema and after stopping methylprednisolone treatment thyroid function normalized and L-thyroxin was discontinued. Two weeks later standard growth hormone stimulation test with clonidine showed partially insufficient growth hormone secretion. During NS remission with normalization of thyroid function (TSH 6.680 mU/l, FT4 13.85 pmol/l) and normalization of IGF-1 level (132 mcg/l) partial catch-up growth was observed (height velocity increased from 3.5 cm/year to 7.3 cm/year, based on 4-month calculation period).Conclusions. Clinicians should be aware of a risk of developing hypothyroidism and consider thyroid function testing during the treatment of children with NS, as well as actively treat hypothyroidism and evaluate growth.

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Non-autoimmune subclinical and overt hypothyroidism in idiopathic steroid-resistant nephrotic syndrome in children

Abstract: The prevalence of subclinical and overt hypothyroidism seems to be high in idiopathic SRNS, with almost one-third of children having overt or subclinical non-autoimmune hypothyroidism.

Cited by 11 publications

References 14 publications

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

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

Thyroid function studies in children of nephrotic syndrome

Overt Hypothyroidism and Severe Growth Retardation in a Preschool Girl with Poorly Controlled Nephrotic Syndrome: Case Report and Literature Review

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