Thyroid Abnormalities in Renal Failure

Abstract

Salt Lake City, UtahFifty-three patients with renal failure on chronic hemodialysis were screened for the presence of goiter. Thirty-one had enlarged thyroid glands, a prevalence of goiter of 58% not previously reported. Thyroid function studies showed low 131 l uptakes, low serum thyroxine and normal serum triiodothyronine and thyrotrophic hormone levels. Serum concentrations of thyroxine-binding globulin were normal; serum albumin concentration was only slightly reduced. Administration of synthetic thyrotrophin-releasing hormone was followed by a rise in serum thyrotrophin and triiodothyronine levels. The cause of the goiter is not known. The possibility that goitrogenic substances are involved is discussed.ALTHOUGH A NUMBER of disturbances in thyroid function have been described in patients with renal failure on chronic hemodialysis (1-3), thyroid enlargement has not been recorded. We have noted the frequent occurrence of goiter in such patients, and for this reason we conducted a systematic study of thyroid function in patients with chronic renal failure on chronic hemodialysis. The results are reported here. Patients and MethodsForty-two patients with renal failure (17 men and 25 women, ages 14 to 35 years) undergoing chronic hemodialysis in the Home Dialysis Training Center at the University of Utah Medical Center and 11 patients with renal failure (10 men and 1 woman, ages 43 to 63 years) on chronic dialysis at the Veterans Administration Hospital in Salt Lake City were screened for goiter. The mean age for the total population studied was 40 years (range, 14 to 61 years). For comparison, we examined 100 persons without renal disease who lived in the same geographic area. The age range (14 to 61 years), the mean age (39 years), and the sex ratio (53 males and 47 females) were similar to those of the patients with chronic renal failure. Goiter was defined as an "enlargement of the thyroid gland to at least twice its normal size, as estimated by palpation of the neck by three different observers." The classification recommended by the World Health Organization (4) was also used.All the patients at the Home Dialysis Training Center at the University of Utah received the following medications: a phosphate binder (aluminum hydroxide), calcium carbonate, multivitamins, and 100-mg, biweekly intramuscular injections of testosterone cypionate (Upjohn Co., Kalamazoo, Michigan). The patients at the Veterans Administration Hospital took the same oral medications but did not receive testosterone. No patients were restricted as to protein intake, and all were dialyzed three times per week, 5 to 6 hours per dialysis, using heparin as the anticoagulant. The patients had been on dialysis from 1 to 48 months (mean, 10 months).The following studies were done: 131 I uptake and thyroid scan, serum thyroxine, triiodothyronine and thyrothrophic hormone levels, triiodothyronine resin uptake, thyroxine-binding globulin capacity, serum albumin concentration, antithyroglobulin and antimicrosomal complement-fixing antibodies, thyroid...

Prevalence of Subclinical Hypothyroidism in Patients with End-Stage Renal Disease and the Role of Serum Albumin: A Cross-Sectional Study from South India

“…In the patients studied by Kaptein et al [13] in 1988, the prevalence of goiter was as high as 43% compared to only 6.7% in the control group. In another report, the prevalence of goiter in ESRD was 58% [14]. Lo et al [10] had correlated hypothyroidism with different levels of estimated GFR according to National Kidney Foundation CKD staging and concluded that reduced kidney function was associated with an increase in the prevalence of SCH and overt hypothyroidism.…”

Thyroid Hormone and the Kidney

“…Nevertheless, some patients may have phys ical signs associated with thyroid disease: R amirez et al [113] observed a 58% incidence o f goiter in chronic hemodialysis patients which they attributed to an unknown goitrogenic substance, and Lim et al [88] found an enlarged thyroid in 30% of their dialyzed patients. In an isolated report, exophthalmos was frequently observed in chronic dialysis patients who were otherwise clinically euthyroid [123].…”

“…PII levels vary considerably in patients on chronic hemodialysis [126], and peritoneal dialysis appears to substitute adequately for the renal excretion of iodide in nephrectomized patients [103], Iodine can also be eliminated by extrarenal routes, anephric individuals being able to excrete increased amounts of iodide in feces, saliva and sweat [103] [113,126] total T4 and FTI levels were reported. Furthermore, T3 was normal in one study [113] but low in two others [88,126], Thyroid hormone concentrations may decrease progressively with longer periods of hemodialysis [126]. Although it appears that total circulating hormone levels are not acutely affected during hemodialysis [37.…”

“…Such discrepancies probably reflect variations in dietary iodide intake and/or the previous administration of iodine-containing radiographic contrast media [91], but they could also be due in part to alterations in the renal tubular handling o f iodide [81,108]. PII levels vary considerably in patients on chronic hemodialysis [126], and peritoneal dialysis appears to substitute adequately for the renal excretion of iodide in nephrectomized patients [103], Iodine can also be eliminated by extrarenal routes, anephric individuals being able to excrete increased amounts of iodide in feces, saliva and sweat [103] [113,126] total T4 and FTI levels were reported. Furthermore, T3 was normal in one study [113] but low in two others [88,126], Thyroid hormone concentrations may decrease progressively with longer periods of hemodialysis [126].…”

Thyroid Function in a Uremic Rat Model

“…Patients with chronic renal failure have low serum levels of total triiodothyronine (TT3)1 due, in part, to a defect in the peripheral conversion of thyroxine (T4) to triiodothyronine (T3) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). However, the physiologic significance of the low serum T3 concentration in a variety of conditions (4)(5)(6), including uremia, has not been clearly defined.…”