Thyroid Dysfunction in Chronic Renal Failure

Vasudevan, C (2010) Thyroid Dysfunction in Chronic Renal Failure. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: “The world is facing a global pandemic of chronic kidney disease. As the morbidity and mortality from infectious diseases decline, life expectancy increases and chronic degenerative diseases have become more prevalent. CKD is unique amongst the chronic non-infectious illnesses…..”. It has been estimated from population survey data that atleast 6% of the adult population in the United States has CKD at stages 1 and 2. An unknown subset of this group will progress to more advanced stages of CKD. An additional 4.5% of the U.S. population is estimated to have stages 3 and 4 CKD. The most frequent cause of CKD is diabetic Nephropathy, most often secondary to Type 2 DM. India being the diabetic capital of the world, diabetic Nephropathy is the commonest cause of CKD. There are about 7.85 million CKD patients in India. Patients with End Stage Renal Disease display a variety of endocrine disturbances. However the evidence of endocrine dysfunction commonly consists only of laboratory abnormalities, many of which are not associated with apparent clinical signs and symptoms of the disease.4 Among which Thyroid function has been extensively evaluated in patients with CRF. CRF is a widely recognised cause of nonthyroidal illness causing thyroid dysfunction, ie, alteration in thyroid hormones in the absence of underlying intrinsic thyroid disorder. Chronic renal failure affects thyroid function in multiple ways, including low circulating thyroid hormone concentration, altered peripheral hormone metabolism, disturbed binding to carrier proteins, possible reduction in tissue thyroid content and increased iodine stores in thyroid glands. TT3, TT4, FT3 are decreased more commonly in patients with CRF. But FT4, TSH levels are normal in these patients and indicate euthyroid status. We speculate that the low thyroid state in uremia serves to defend against protein wasting and misguided attempts to replete thyroid hormone stores may worsen protein malnutrition. Some studies showed an increased incidence of subclinical hypothyroidism in CKD patients and higher prevalence of hypothyroidism in patients with terminal renal failure. It has been estimated that primary hypothyroidism may occur in upto 9.5% of ESRD patients when compared to 0.6 to 1.1% of general population. When hypothyroidism becomes more severe it can cause reduced cardiac function and lead to progressively worsening kidney function. Thus the prevalence of subclinical hypothyroidism in patients with CKD might be a risk factor for both cardiovascular disease and progressive kidney disease. This study is designed to determine the prevalence of thyroid dysfunction in CRF patients in order to intervene at an early stage depending upon the hormone abnormalities and reduce both the cardiovascular risk and progressive worsening of kidney function. AIM OF THE STUDY: 1. To determine the prevalence of thyroid dysfunction in chronic renal failure patients in stages 3,4 and 5. 2. To correlate the prevalence of thyroid hormone abnormalities with increasing degrees of renal insufficiency. MATERIALS AND METHODS: Subjects: Patients admitted in the Department of Medicine and Nephrology who fulfilled the Inclusion and Exclusion Criteria. Study design: Cross sectional study. Study setting: Govt. Rajaji Hospital, Madurai. Study Duration: August 2008 to October 2009. Study Criteria: Inclusion Criteria: Newly detected CRF patients with chronic renal insufficiency defined as; 1. An estimated creatinine clearance of < 60 ml/mt. (Stages 3,4 & 5), 2. USG evidence of chronic renal failure. Exclusion Criteria: 1. Previously known hypothyroid patients, 2. Patients on high dose of frusemide therapy > 100 mg/day, 3. On heparin therapy, 4. On steroid therapy, 5. On antiepileptics like phenytoin, phenobarbitone, 6. On sulphonylureas, 7. On propranolol. RESULTS: Most of the patients in the sample were in the age group of 51-60 years. The range was from 23 to 75 years. Of the 40 patients in the sample 30 patients were males, and 10 patients were females. Of the 40 patients with CRF, 11 patients (27.5%) were diabetic. Of the 40 patients with CRF, 8 patients (20%) only were symptomatic and majority (80%) were asymptomatic. Of the 40 patients with CRF, 7 patients (17.5%) had goiter. Of the 40 patients in this sample, 6 patients belonged to stage 3, 11 patients to stage 4 and 23 patients to stage 5. The Table shows that symptoms of hypothyroidism are prominent with advanced stages of renal failure. Of the 40 patients in this sample, 3 patients (7.5%) had hypothyroidism, 6 patients (15%) had subclinical hypothyroidism, 17 patients (42.5) had some thyroid hormone abnormalities. Totally 26 patients (65%) had some thyroid dysfunction. Of the 40 patients in this study group 23 patients had stage 5CKD. The prevalence of goiter was 0% in stage 3 CKD, 9.1% in stage 4 CKD and 26.1% in stage 5 CKD. The higher the stage of CKD, the higher was the prevalence of goiter. CONCLUSION: In our study, the overall prevalence of thyroid dysfunction is 65% in patients with chronic kidney disease. • 7.5% of CKD patients had hypothyroidism. • 15% had subclinical hypothyrodism. • 42.5% had some thyroid hormone abnormalities. • 17.5% of CKD patients had goiter. There was a significant correlation between the prevalence of thyroid dysfunction and the stage of chronic kidney disease. • Higher the degree of renal insufficiency, the higher was the prevalence of thyroid hormone abnormalities.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Thyroid Dysfunction ; Chronic Renal Failure.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 16 Mar 2018 03:31
Last Modified: 16 Mar 2018 03:31
URI: http://repository-tnmgrmu.ac.in/id/eprint/6292

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