A study on thyroid function in patients on chronic dialysis Masahumi Kikkawa, Issei Tanaka, Naoki Haruta, Takao Hinoi, Tamaki Nakatani, Kazuaki Miyamoto Artifical Kidney Center, Hiroshima Prefectural Hiroshima Hospital Thyroid function was investigated in 63 patients on chronic dialysis, consisting of 53 hemodialysis and 10 CAPD cases. Original causes of chronic renal failure were chronic glomerulonephritis (CGN) (n=35), diabetes mellitus (DM) (n=18) and others. All cases filled out questionnaire surveys on subjective symptoms and serum free triiodothyronine (F-T3), free thyroxine (F-T4), thyrotropin (TSH), thyroglobulin antibody and microsome antibody levels were determined. In addition, total triiodothyronine (T-T3), total thyroxine (T-T4) and thyroxine binding globulin (TBG) in serum were also measured in 35 patients younger than sixty-five years old. A given amount of thyroid hormone preparation was administered to the other patients to analyze the kinetics of thyroid hormone concentrations, and to investigate whether their clinical symptoms improved or not. Subjective symptoms of these patients were very similar to those of hypothyroidism. Antithyroid antibodies were negative except in two patients, indicating no complications of chronic thyroiditis. Serum F-T3 and F-T4 in all patients were 1.6 }0.7pg/ ml and 0.55 }0.26ng/dl, respectively. These values were much lower than normal, indicating that these patients
were in a hypothyroid state. On the other hand, serum TSH levels in all patients were higher than normal (10.81 } 33.2ƒÊU/ml), with large variations. To investigate this variation further, they were subdivided into two groups, those with normal TSH and those with high TSH. DM patients were mostly found (p<0.005) in the high TSH group, as compared to normal. Moreover, the serum TSH level was significantly higher in DM patients than in CGN patients (30.5 }58.6 vs 3.1 }2.3ƒÊU/ml, p<0.01). Serum F-T3 and F-T4 levels were significantly lower in DM patients than in CGN patients (1.2 }0.7 vs 1.7 }0.7 pg/ml, p<0.05 and 0.4 }0.2 vs 0.6 }0.3ng/ml, p<0.005, respectively). These results suggested that the DM patients might be classified into a specific category with respect to hypothyroidism patients. Some of the other patients in the hypothyroid state on chronic dialysis were experimentally placed on dried thyroid powder or Thyradin S_??_. The use of dried thyroid powder was considered to be preferrable and more effective than that of Thyradin S_??_, because the latter did not cause an elevation in the F-T3 level.
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