Thyroid dysfunction and kidney disease

Abstract

Thyroid hormones (TH) are essential for an adequate growth and development of the kidney. Conversely, the kidney is not only an organ for metabolism and elimination of TH, but also a target organ of some of the iodothyronines' actions. Thyroid dysfunction causes remarkable changes in glomerular and tubular functions and electrolyte and water homeostasis. Hypothyroidism is accompanied by a decrease in glomerular filtration, hyponatremia, and an alteration of the ability for water excretion. Excessive levels of TH generate an increase in glomerular filtration rate and renal plasma flow. Renal disease, in turn, leads to significant changes in thyroid function. The association of different types of glomerulopathies with both hyper-and hypofunction of the thyroid has been reported. Less frequently, tubulointerstitial disease has been associated with functional thyroid disorders. Nephrotic syndrome is accompanied by changes in the concentrations of TH due primarily to loss of protein in the urine. Acute kidney injury and chronic kidney disease are accompanied by notable effects on the hypothalamus-pituitary-thyroid axis. The secretion of pituitary thyrotropin (TSH) is impaired in uremia. Contrary to other non-thyroidal chronic disease, in uraemic patients it is not unusual to observe the sick euthyroid syndrome with low serum triodothyronine (T 3 ) without elevation of reverse T 3 (rT 3 ). Some authors have reported associations between thyroid cancer and kidney tumors and each of these organs can develop metastases into the other. Finally, data from recent research suggest that TH, especially T 3 , can be considered as a marker for survival in patients with kidney disease.

Relationship between serum TSH levels and intrarenal hemodynamic parameters in euthyroid subjects

“…Our study may also be consistent with the results that TSH positively correlated with creatinine in hypothyroid subjects (22). Low cardiac output may also be associated with decreased RBF in hypothyroidism (23).…”

Prevalence of thyroid autoimmunity and subclinical hypothyroidism in persons with chronic kidney disease not requiring chronic dialysis

“…Conversely, a marked decline in kidney function is accompanied by changes in the synthesis, secretion, metabolism, and elimination of thyroid hormones (1,2).…”

“…This linkage becomes more evident in clinically overt hyperthyroidism and hypothyroidism. These conditions lead to hemodynamic and vascular changes in the kidney, as well as to changes in the structure and function of the tubules and glomerulus (1). An increased prevalence of goiter and thyroid gland volume has been reported in patients with chronic kidney disease (CKD) (2,3).…”

“…An increased prevalence of goiter and thyroid gland volume has been reported in patients with chronic kidney disease (CKD) (2,3). It has been suggested that clinically overt hypothyroidism may be more common in patients with CKD compared with the general population (1).…”

Baseline Levels and Trimestral Variation of Triiodothyronine and Thyroxine and Their Association with Mortality in Maintenance Hemodialysis Patients

“…Recent reports suggest that as many as 70% of patients with ESRD present with low T3 levels (2)(3)(4)(5) and as many as 20%-25% have subclinical hypothyroidism (6,7). The underlying pathophysiology of these derangements is likely multifactorial, involving iodine retention, altered serum protein binding capacity, systemic inflammation, and peripheral deiodinase activity (8,9).…”