Reversible primary hypothyroidism and elevated serum iodine level in patients with renal dysfunction

Sato, Kaori; Okamura, Ken; Yoshinari, Mototaka; Kuroda, Takeo; Ikenoue, Hiroshi; Okazawa, Kaeko; Mizokami, Tetsuya; Onoyama, Kaoru; Fujishima, Masatoshi

doi:10.1530/acta.0.1260253

Cited by 50 publications

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“…Elevation of serum iodine levels result in prolongation of the Wolff-Chaikoff effect [21]. Iodine excess has been linked to increased prevalence of goiter and hypothyroidism reported in CKD [14,22]. A high exposure to iodine facilitates the development of hypothyroidism in CKD patients [23].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Characteristics of Hypothyroidism in a Population Undergoing Maintenance Hemodialysis

Paudel¹

2014

JCDR

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Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Characteristics of Hypothyroidism in a Population Undergoing Maintenance Hemodialysis

Paudel¹

2014

JCDR

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“…Therefore, the excess serum iodine observed in our 2 cases may have been responsible for the development of hypothyroidism through the Wolff-Chaikoff effect. However, predisposition of the thyroid gland seems to be a prerequisite for failure to escape from the inhibitory effect of excess iodine, because not all patients with elevated serum non-hormonal iodine levels develop hypothyroidism [18]. A prolonged inhibitory effect of iodine has already been reported in nephrectomized rats by Wolff and Chaikoff [19].…”

Section: Discussionmentioning

confidence: 98%

“…Recently, Takeda et al [21] reported 3 cases on regular dialysis treatment accompanied by iodineinduced reversible hypothyroidism and the overall prevalence of this condition among patients on regular hemodialysis or continuous ambulatory peritoneal dialysis was 3.2% (3/93). Furthermore, Sato et al [18] reported that among 245 patients with primary hypothyroidism (serum TSH > 10 mU/1), 36 patients were associated with renal dysfunction which was defined as the serum creatinine level > 106 amol/1. Recovery of thyroid function after iodine restriction in these patients was observed in 30 (83%), in whom an elevated serum non-hormonal iodine level (median 236, range 67-15591 pg/l, N=19) was observed.…”

Section: Discussionmentioning

confidence: 99%

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Diabetic Nephropathy Accompanied by Iodine-Induced Non-Autoimmune Primary Hypothyroidism: Two Case Reports.

et al. 1999

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Abstract.We reported 2 diabetic patients with nephrotic syndrome due to advanced diabetic nephropathy complicated by non-autoimmune primary hypothyroidism. Hypothyroidism developed along with the anasarcous status. Histological examinations of the thyroid gland revealed almost normal thyroid follicles without lymphocytic infiltration.The amounts of thyroid hormone lost into the extravascular space such as in urine and ascites were not sufficient to cause hypothyroidism alone. Serum total iodine levels measured during the hypothyroidal state in both cases were definitely elevated, and the perchlorate discharge test of both cases showed positive discharge (24 and 34%, respectively). The thyroid functions normalized after iodine restriction in the first case and initiating hemodialysis in the second case, in parallel with normalization of serum total iodine levels. These findings suggest that impaired renal handling of iodine resulting in elevation of serum iodine levels, rather than an autoimmune mechanism or extravascular hormone loss, played a principal role in the development of primary hypothyroidism found in these 2 patients, probably through a prolonged Woli Chaikoff effect. secondary to diabetic neuropathy and peripheral vascular disease have been recognized. However, the etiology that plays a major role in accelerating extravascular fluid retention has yet to be elucidated. Hypothyroidism is commonly associated with extravascular fluid retention through increased capillary transudation of protein associated with decreased cardiac output and renal blood flow [3]. Therefore, deterioration of the anasarcous status may occur when hypothyroidism develops in cases showing a preexisting nephrotic state. We reported here, 2 diabetic cases of nephrotic syndrome due to advanced diabetic nephropathy complicated by nonautoimmune primary hypothyroidism, in which hypothyroidism developed along with deterioration of the anasarcous status and was likely caused by an intrathyroidal iodine organification defect.

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“…The serum levels of free T4 (fT4; normal range, 12-23 pmol/l), thyroglobulin (Tg; normal range, <30 ng/ml), total iodine (normal range, 4.0-9.0 µg/ dl), the hemagglutination test for either antithyroglobulin antibody (TGHA) or anti-thyroid microsomal antibody (MCHA), TSH-binding inhibitor immunoglobulin (TBII; normal range, <15%), and thyroidal RAIU were all measured by the method reported previously [5,6]. The serum TSH levels were determined by a sensitive immunoradiometric assay (Hoechst Pharmaceutical Co., Tokyo, Japan; normal range, 0.50-4.05 mU/l).…”

Section: Introductionmentioning

confidence: 99%

Acute Spontaneous Hemorrhagic Degeneration of the Thyroid Nodule with Subacute Thyroiditis-Like Symptoms and Laboratory Findings.

et al. 1995

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Abstract.Seventeen consecutive patients (3 men and 14 women, aged 14-75 years) with a hemorrhagic degeneration of the thyroid nodule, which was confirmed by both ultrasonography and either reddish or brown fluid evacuated by fine-needle aspiration, were classified as either acute type with an episode of abrupt painful swelling of the thyroid (n=4), or chronic type in which a painless thyroid nodule was incidentally found (n=13). One of the four acute type patients demonstrated subacute thyroiditis-like symptoms and laboratory findings including transient painful thyrotoxicosis associated with high serum levels of thyroid hormones and thyroglobulin (Tg), a suppressed serum TSH level, a low thyroidal radioactive iodine uptake (RAIU), and an accelerated erythrocyte sedimentation rate (ESR). In the other three acute type patients the serum level of Tg increased markedly, the serum thyroid hormones level increased in one, the thyroidal RAIU was low in two, and the ESR was accelerated in one. In the thirteen chronic type patients, the serum levels of the thyroid hormones and the thyroidal RAID were within the normal range, and few inflammatory signs were observed. These findings suggest that acute hemorrhagic degeneration of the thyroid nodule may thus cause transient subacute thyroiditis-like symptoms and laboratory findings.

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Reversible primary hypothyroidism and elevated serum iodine level in patients with renal dysfunction

Cited by 50 publications

References 0 publications

Prevalence and Clinical Characteristics of Hypothyroidism in a Population Undergoing Maintenance Hemodialysis

Prevalence and Clinical Characteristics of Hypothyroidism in a Population Undergoing Maintenance Hemodialysis

Diabetic Nephropathy Accompanied by Iodine-Induced Non-Autoimmune Primary Hypothyroidism: Two Case Reports.

Acute Spontaneous Hemorrhagic Degeneration of the Thyroid Nodule with Subacute Thyroiditis-Like Symptoms and Laboratory Findings.

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