Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 577 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

ORIGINAL ARTICLE Table of Contents   
Year : 1996  |  Volume : 7  |  Issue : 3  |  Page : 297-300
Thyroid Function in Children with Chronic Renal Failure


Jeddah Kidney Center, King Fahad Hospital, Jeddah, Saudi Arabia

Click here for correspondence address and email
 

   Abstract 

This study was undertaken to test the thyroid function in non-dialyzed children with chronic renal failure (CRF). Sixteen children with CRF and 12 healthy children who served as controls were studied for their thyroid function status. We found a significant increase in the serum thyroid stimulating hormone (TSH) level and a significant decrease in serum Triiodo thyronine (T3) levels in children with CRF as compared to the healthy children (p < 0.001). No significant difference was found between children with CRF and healthy children as regards serum thyroxine (T4) and serum free T4 (FT4) (p > 0.2). There was a weak negative correlation between hemoglobin concentration and serum TSH (r = - 45) as well as between blood urea nitrogen and serum T3 (r= -0.30) in children with CRF. These results suggest that children with CRF commonly have a state of biochemical hypothyroidism although they are clinically euthyroid. Early renal transplantation is indicated to correct such metabolic defects.

Keywords: Chronic renal failure, Children, Pre-dialysis, Thyroid function

How to cite this article:
El-Hana NA, El Shaikh S, Shaheen FA. Thyroid Function in Children with Chronic Renal Failure. Saudi J Kidney Dis Transpl 1996;7:297-300

How to cite this URL:
El-Hana NA, El Shaikh S, Shaheen FA. Thyroid Function in Children with Chronic Renal Failure. Saudi J Kidney Dis Transpl [serial online] 1996 [cited 2020 Sep 28];7:297-300. Available from: http://www.sjkdt.org/text.asp?1996/7/3/297/39493

   Introduction Top


Thyroid hormones, thyroxine (T4) and triiodo thyronine (T3) play an important role in the maturation and development of the skeleton and affect endochondral calcifycation and the entire process of cartilage growth. In contrast to testosterone and estrogen, the thyroid hormones stimulate the proliferation of cartilage as well as epiphyseal maturation [1] . The kidney plays a role in the metabolism and clearance of these hormones as well as thyroid-stimulating hormone (TSH) and thyrotropin releasing hormone (TRH). Normally, only trace quantities of iodothyronines, TSHor TRH are excreted in the urine [2] . Also, kidney tissue processes a thyrozine-5 deiodinase which converts T4 to T3 [3]

Children with CRF share non-specific clinical manifestations seen in hypothyroidism, such as lethargy, poor appetite, constipation, fatigue, yellowish complexion, growth retardation, dry skin and cold intolerance [4] . In spite of extensive studies, the issue of thyroid function in children with CRF remains inconclusive [5] . Several factors such as the type of kidney disease e.g., protein-loosing nephropathies; treatment with immuno­suppressive drugs for specific renal diseases; the degree and duration of renal failure; the extent of malnutrition; dietary factors, e.g., protein restriction; dialysis, either hemodialysis (HD) with heparin or continuous ambulatory peritoneal dialysis (CAPD);drugs such as anti-hypertensive adrenergic blockers or corticosteroids, and renal transplantation may all influence the results of thyroid function tests [2] . We tested the thyroid function in non-dialyzed children with CRF as well as healthy controls in order to determine their thyroid status.


   Materials and Methods Top


The study was performed on 16 children with CRF not yet on dialysis therapy, and 12 healthy children who served as controls. The children with CRF were studied at the time of follow-up in the pediatric nephrology outpatient clinic of the Jeddah Kidney Center (JKC), Saudi Arabia. None of the study children were on anti-hypertensive drugs, corticosteroids or immunosuppressive drugs. Standard laboratory investigations including complete blood count, blood chemistry, ESR and urine and stool analysis were performed on all patients. The thyroid function was studied by measuring serum levels of TSH, T3, T4 and free T4 by ELISA method using the fully automated ES700 system and the reagents were supplied by Boehringer Mannhein Company.


   Results Top


The study children with CRF were aged between 1.5 and 15 years with a mean age of seven years. There were 10 (62.5%) boys and six (37.5%) girls. The age of the control group ranged between 2.5 and 14 years with a mean of 7.1 years. There were seven (58.3%) boys and five (41.7%) girls in this group. The etiology of CRF in this series was as follows: six (37.5%), chronic glomerulonephritis; four (25%), urinary tract obstruction; three (18.5%), renal hypoplasia; one (6.5%), hemolytic uremic syndrome and two (12.5%), unknown etiology.

The hemoglobin (Hb) concentration in children with CRF ranged between 51-89 gm/L, with a mean value 71 gm/L, while that in the control group ranged between 114 to 132 gm/L with a mean value of 123 gm/L, a difference that was statistically significant. The values of blood urea nitrogen (BUN) and serum creatinine in the children with CRF as well as healthy controls are given in [Table - 1]. As expected, there was a significant increase of these parameters in the children with CRF (P< 0.001).

The serum thyroid hormone profile in the study patients and controls is given in [Table - 2]. The mean serum TSH in children with CRF was 4.36 ± 1.61µU/ml, while in control children it was 2.58 ± 0.57 µU/ml, a difference that was statistically significant (P< 0.001). The mean value of serum T3 in children with CRF was 113.18 ± 17.13 ng/dl, while in the control children, it was 131.56 ± 4.26 ng/dl. Thus, there was a significant decrease in the mean value of serum T3 in children with CRF (p<0.001). The mean serum T4 levels in children with CRF was 6.15 ± 1.52 /ig/dl, while in control children it was 6.33 ± 1.21 fig/dl, a difference that was not statistically significant (p>0.2). The serum free T4 in children with CRF showed a mean value of 1.22 ± 0.15 ng/dl, while in the control children, the mean value was 1.19 ± 0.1 ng/dl. Again, the difference was not statistically significant. (p>0.2).

There was a weak negative correlation between Hb and serum TSH concentration (r= -0.45), but no correlation existed between Hb and serum T3 levels. Also, there was no correlation between BUN of children with CRF and serum TSH while there was a weak negative correlation (r= - 0.30) with serum T3. There was no correlation between serum creatinine and serum T3 of children with CRF.


   Discussion Top


The present study demonstrates the thyroid function status in children with CRF not yet on dialysis therapy. We noted a state of hypothyroidism in some of these children as evidenced by the significant increase in their serum TSH and decrease in serum T3 levels. Thus, these children were in a state of biochemical hypothyroidism, though clinically euthyroid.

Normal serum TSH levels have been reported in adults [6] and children [7],[8] with CRF. Low serum TSH levels have been reported in adults with CRF on prolonged hemodialysis [9] , but similar data on children are lacking in literature. In our study, there was a significant increase in the mean serum TSH in children with CRF when compared to healthy children, a result that is in accordance with the results of Ijaiya [10] and Sakurai, et al [11] . Similar high serum TSH levels have been reported in adults with CRF on conservative management [12] . The increase in serum TSH in the study children with CRF may be attributed to the increase in half-life of TSH in CRF and/or significant low serum T3 levels seen in these patients.

Our study demonstrated low levels of serum T3 in children with CRF when compared to healthy controls. These results are in agreement with data obtained from Savdie, et al [13] and Hardy, et al [14] in children with CRF and Lims, et al [6] , Sakurai, et al [11] , and Kayirna et al [12] in adults with CRF. Lims. et al [6] mentioned that low serum T3 concentration may confer a protective effect on patients with CRF regarding protein-nitrogen conservation and provide a rationale for not correcting such deficiency. The finding of low serum T3 in children with CRF may be accounted for by the limitation of protein calorie intake due to anorexia in the diseased children, exaggerated catabolism which occurs in uremic patients as well as contribution of protein restriction imposed on most of these patients [15] . No studies exist reporting increased serum T3 levels in patients with CRF.

Normal serum T4 levels have been reported in adults [12] and children [16] with CRF on conservative management. These are similar to our results which demonstrated no significant difference in the serum T4 levels between CRF children and healthy controls. However, low serum T4 levels have been reported in adults with CRF on conservative treatment by Hegedus, et al [17] , and in children with CRF by Kaptein, et al [8] . They attributed low serum T4 to the effect of uremic factor which alters binding of T4 to thyroid binding globulin (TBG) or displacement of T4 from TBG [18] .

Kayima, et al [12] reported low serum free T4 in adults with CRF on conservative management. Also, Hershman, et al [1],[2],[3],[4],[5],[6],[7],[8],[9] and Hardy, et al [14] observed low serum free T4 in children with CRF. They attributed this finding to the disturbed peripheral, metabolism of thyroid hormones in patients with CRF. Our study demonstrated normal serum free T4 in children with CRF, which is in accordance with that of Wassner, et al [20] and Tikanoja, et al [21] .

In conclusion, our study revealed that biochemical hypothyroidism is commonly seen in children with CRF although they are clinically euthyroid. Thyroid hormone treatment may be indicated only if there is clinical and biochemical evidence of hypothyroidism and only after doing other confirmatory tests. However, caution should be exercised before initiating replacement therapy. Successful renal transplantation leads to normalization of thyroid hormone concentrations in children with CRF [22] . Hence, early renal transplantation is indicated in such children.

 
   References Top

1.Klenar CJ. Endocrine gland disorders. Forfar and Arneil's text book of ped 4th ed. Campbell, A.G. and Mclntosh N. London New York and Tokyo, 1992.  Back to cited text no. 1    
2.La Franchi S. Thyroid function in children with chronic renal failure. J Pediatr 1991;118(6):896-8.  Back to cited text no. 2    
3.Oppenheimer JH. Distribution and metabolism of the thyroid hormone, in Burrow GN, Oppenheimer JH, Volpe R, (eds): Thyroid function and disease. Philadelphia. WB Saunders. 1989;65-89.  Back to cited text no. 3    
4.Rauh W, Joachim P. Endocrine function in children with ESRD. End stage renal disease in children. Fine R and Gruskin, A. W.B. Saunders Co. London, Toronto, Sydney, Tokyo. 1984.  Back to cited text no. 4    
5.Verger MF, Verger C, Hatt Magnien D, Perrone F. Relationship between thyroid hormones and nutrition in chronic renal failure. Nephron 1987;45:211-5.  Back to cited text no. 5    
6.Lims VS, Flanigan M, Zavala DC, Freeman M. Protective adaptation of low serum triiodothyr-onine in patients with chronic renal failure. Kidney Int 1985;28:541-9.  Back to cited text no. 6    
7.Giordano C, De Santo NG, Carella C, et al. TSH response to TRH in hemodialysis and CAPD patients. Int J Artif Organs 1984;7:7-10.  Back to cited text no. 7    
8.Kaptein EM, Quion-Varde H, Chooljian CJ, et al. The thyroid in end-stage renal disease. Medicine Baltimore 1988;67:187-97.  Back to cited text no. 8    
9.Drabczyk R, Grzeszczak W, Trelewicz P. Influence of long term hemodialysis treatment on TSH secretion in patients with chroni renal failure. Pol Arch Med Wewn 1992;88(6):381-91.  Back to cited text no. 9    
10.Ijaiya K. TSH and PRL response to thyrotropnin-releasing hormone in children with chronic renal failure undergoing hemodialysis. Arch Dis Child 1979;54:937-41.  Back to cited text no. 10    
11.Sakurai S, Hara Y, Miura S, et al. Thyroid functions before and after maintenance hemodialysis in patients with chronic renal failure. Endocrinol Jpn 1988;35(6):865-76.  Back to cited text no. 11    
12.Kayima JK, Otieno LS, Gitau W, Mwai S. Thyroid hormone profiles in patients with chronic renal failure on conservative management and regular hemodialysis. East Afr Med J 1992;69(6):333-6.  Back to cited text no. 12    
13.Savdie E, Stewart JH, Mahony JF, Hayes JM, Lazarus L, Sumons LA. Circulating thyroid hormone levels and adequacy of dialysis. Clin Nephrol 1978;9:68-72.  Back to cited text no. 13    
14.Hardy MJ, Ragbeer SS, Nascimento L. Pituitary thyroid function in chronic renal failure assessed by a highly sensitive thyrotropin assay. J Clin Endocrinol Metab 1988;66:233-6.  Back to cited text no. 14    
15.Gardner DF, Kaplan MM, Stanley CC, Utiger RD. Effect of tri­iodo thyronine replacement on the metabolic and pituitary responses to starvation. N Engl J Med 1979;300:579-84.  Back to cited text no. 15    
16.Afrasiabi MA, Vaziri ND, Gwinup G, et al. Thyroid function studies in the nephrotic syndrome. Ann Intern Med 1979;90:335-8.  Back to cited text no. 16    
17.Hegedus L, Anderson JR, Poulsen LR, et al. Thyroid gland volume and serum concentrations of thyroid hormones in chronic rena failure. Nephron 1985;40(2): 171-4.  Back to cited text no. 17    
18.Castro N, Scafidi V, Costanzo G, Notarbartolo A. Prospective study on thyroid function anomalies in severely ill patients. Ann Ital Med Int 1992;7(l):13-8.  Back to cited text no. 18    
19.Hershman JM, Krugman LG, Kopple JD, Reed AW, Azukizawa M, Shinaberger JH. Thyroid function in patients undergoing maintenance hemodialysis: unexplained low serum thyroxine concentration. Metabolism 1978;27:775-9.  Back to cited text no. 19    
20.Wassner SJ, Buckingham BA, Kershnar AJ, Malekzadeh MH, Pennnisi AJ, Fine RN. Fine R. Thyroid function in hildren with chronic renal failure. Nephron 1977;19:236-41.  Back to cited text no. 20    
21.Tikanoja SH, Joutti A, Liewendahl BK. Association between increased concentrations of free thyroxine and unsaturated free fatty acids in non­thyroidal illnesses: role of albumin. Clin Chim Acta 1989;179:33-43.  Back to cited text no. 21    
22.Cowden EA, Rateliffe WA, Kennedy AC. Hypothalamic-pituitary function in uremia. Acta Endocrinol Copenh 1981;98:488.  Back to cited text no. 22    

Top
Correspondence Address:
Nagi Abu El-Hana
Department of Nephrology, Jeddah Kidney center, King Fahd Hospital, Jeddah
Saudi Arabia
Login to access the Email id


PMID: 18417946

Rights and Permissions



 
 
    Tables

  [Table - 1], [Table - 2]



 

Top
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    References
    Article Tables
 

 Article Access Statistics
    Viewed2620    
    Printed91    
    Emailed0    
    PDF Downloaded347    
    Comments [Add]    

Recommend this journal