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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2015  |  Volume : 26  |  Issue : 1  |  Page : 90-93
Evaluation of thyroid hormone levels in chronic kidney disease patients

1 Department of Biochemistry, Akash Institute of Medical Sciences and Research Centre, Bangalore, India
2 Department of Biochemistry, NRI Medical College and General Hospital, Guntur, India
3 Department of Biochemistry, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, India
4 Department of Nephrology, NRI Medical College and General Hospital, Guntur, India

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Date of Web Publication8-Jan-2015


We attempted in this study to determine the thyroid hormone levels in 45 adult chronic kidney disease (CKD) patients and 45 ageand sex-matched healthy subjects as controls. The serum thyroid hormone levels were measured by a radioimmunoassay. Serum concentrations of creatinine, urea, electrolytes and total proteins and albumin were measured as well. There was a significant decrease in the levels of serum total T3, total T4 and total protein and albumin levels in CKD patients when compared with the controls. There was a significant increase in the level of thyroid stimulating hormone in the CKD patients compared with the controls. Our study suggests that CKD leads to significant changes in the thyroid hormone levels, which need to be interpreted carefully in these patients.

How to cite this article:
Rajeev G, Chickballapur Rayappa WD, Vijayalakshmi R, Swathi M, Kumar S. Evaluation of thyroid hormone levels in chronic kidney disease patients. Saudi J Kidney Dis Transpl 2015;26:90-3

How to cite this URL:
Rajeev G, Chickballapur Rayappa WD, Vijayalakshmi R, Swathi M, Kumar S. Evaluation of thyroid hormone levels in chronic kidney disease patients. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2022 Dec 8];26:90-3. Available from: https://www.sjkdt.org/text.asp?2015/26/1/90/148749

   Introduction Top

The endocrine abnormalities are a common feature of chronic kidney disease (CKD). [1],[2]

The kidney normally plays an important role in the metabolism, degradation and excretion of thyroid hormones. CKD affects thyroid function in many ways, including low circulating thyroid hormone levels, altered peripheral hormone metabolism, insufficient binding to carrier proteins, reduced tissue thyroid hormone content and altered iodine storage in the thyroid gland. [3]

In patients with nephrotic syndrome, the loss of thyroid hormones may result in low thyroid hormone levels unless production is increased under the influence of thyroid stimulating hormone (TSH). Furthermore, loss of albumin and thyroxin binding globulin (TBG) may reduce the binding capacity for the thyroid hormones, resulting in a decrease in total tri-iodothyronin (T3) and total thyroxin (T4) concentrations. [4]

Knowledge of alterations of thyroid hormone metabolism in euthyroid end-stage renal disease (ESRD) patients is required to accurately diagnose and treat concurrent hypothyroidism and hyperthyroidism. Furthermore, thyroid diseases, including goiter, hypothyroidism, thyroid nodules and thyroid cancer, may occur more frequently in ESRD patients than in the general population and may be under-diagnosed due to limited clinical awareness. [1],[5]

Because limited information is available on the relationship between thyroid hormone levels and CKD, we aimed in the present study to evaluate the serum thyroid hormone levels in CKD patients.

   Materials and Methods Top

In this cross-sectional, case-control study, we studied 45 adult CKD patients who visited the Department of Nephrology, NRI Medical College and General Hospital; 26 patients were male and 19 patients were female, with duration of CKD < 5 years. Institutional ethics committee clearance was obtained prior to the study and informed consent was obtained from the subjects participating in this study.

Forty-five ageand sex-matched healthy individuals were included as controls. Patients with clinically diagnosed chronic renal failure (on conservative management before dialysis) due to chronic glomerulonephritis and other glomerular diseases, chronic pyelonephritis and obstructive uropathy with serum creatinine levels more than 3.0 mg/dL were included in the study. CKD with diabetes mellitus/essential hypertension/liver diseases/coronary artery disease/vasculitis/thyroid disorders on treatment/ other auto-immune disorders were excluded. The clinical history and other necessary details were obtained from the patients' medical records.

The levels of thyroid hormones were measured using the method of radioimmunoassay (ADVIA Centaur CP, Siemens Medical Solutions USA, Inc., 51 Valley Stream Parkway, Malvern, PA 19355, United States). Serum concentrations of creatinine, urea, total proteins and albumin were measured using commercial kits adapted to the Dade Behring Dimension auto-analyzer. Serum sodium and potassium were measured using a Roche AVL 9180 electrolyte analyzer Roche Diagnostics, India Pvt Ltd, 501/601 B, Silver Utopia, Cardinal Gracious Road, Chakala Andheri(E), Mumbai 400069, India.

   Statistical Analysis Top

All continuous variables are expressed as the mean ± standard deviation (SD). We compared the data of the controls with the study group using unpaired Student's "t" test. We used the Statistical software (SPSS, version 18.0) for the analysis of the data. We considered the level of significance, P-value ≤ 0.05 as significant.

   Results Top

There was a significant difference between the study group and the controls with respect to serum TSH levels. Serum total T3 and total T4 levels were significantly less in the study patients compared with the controls. Serum patients compared with the controls. Serum potassium levels were not altered significantly in the CKD patients. Total protein, albumin and sodium levels were significantly decreased in the CKD patients [Table 1].
Table 1: Comparison of measured parameters in healthy controls and chronic kidney disease patients.

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Serum total T3 concentration was less than the normal range in 40 of the 45 (88%) CKD patients. The mean serum total T3 concentration of 0.61 ± 0.24 ηg/mL in the CKD patients was significantly lower than that in the control subjects 1.15 ± 0.35 ηg/mL (< 0.05).

In addition, 15 (33%) patients had lower total serum T4 concentration than the controls. The mean total T4 concentration of 6.90 ± 2.44 μg/dL in the CKD patients was significantly lower than that in the control subjects, 8.4 ± 1.95 μg/dL (P < 0.002).

Finally, the serum TSH concentration was increased in 27 patients (60%) among those with CKD. The mean serum TSH concentration was 7.19 ± 4.17 μIU/mL in the CKD patients, which was significantly increased than in the controls (2.73 ± 1.38 μIU/mL) (P < 0.000).

   Discussion Top

In CKD, thyroid hormone metabolism is impaired. All levels of the hypo-thalamic-pituitary-thyroid axis may be involved, including alterations in hormone production, distribution and excretion. Pre-dialysis CKD patients have an increased risk of hypothyroidism. [6],[7],[8] The incidence of thyroid dysfunction in CKD patients is greater than that found among the general population. [9]

Moreover, impaired conversion of T4 and T3 may be related to malnutrition and humoral factors including cytokines that are generally associated with CKD. [2] In our study, serum total T3 concentration was significantly lower than the normal range in the majority of the CKD patients in comparison with the controls. Similar findings were observed by Rajagopalan et al, Magaña et al, Gilles et al and Iglesias et al. [8],[9]

Inhibitors of T4 binding to serum carrier proteins and urinary loss of TBG, albumin and pre-albumin contribute to the decreased levels of the T4 in CKD patients. [2],[8] In our study, one-third of the CKD patients had significantly lower total serum T4 concentration than the controls. Similar findings were observed by other investigators. [4],[7],[9]

Serum TSH concentrations are usually normal or elevated in CKD, but its response to its releasing hormone (TRH) is generally low. [9] Both proteinuria and GFR influence the activity of the pituitary-thyroid axis. [4],[6] In our study, serum TSH concentration was significantly increased in 60% of the CKD patients. Similar findings were observed by previous studies. [4] In contrast, others found serum TSH levels to be normal or unchanged in the CKD patients.

We conclude that our data suggest that CKD results in significant changes in thyroid hormone levels and it is advisable to assess the degree of thyroid dysfunction in the CKD patients.

Conflict of Interest: None declared.

   References Top

Parameswaran S. Chronic kidney disease in India. Health Sci 2012;1:JS001.  Back to cited text no. 1
Singh PA, Bobbay Z, Selvarajan N, Vinayagamoorthi SR. An evaluation of Thyroid Hormone Status in Oxidative Stress in Undialyzed Chronic Renal Failure Patients. Indian J Physiol Pharmacol 2006;3:279-84.  Back to cited text no. 2
Malyszko J, Malyszko J, Wolczynski S, Mysliwiec M. Adinonectin, leptin and thyroid hormones in patients with chronic renal failure and on renal replacement therapy: Are they related? Nephrol Dial Transplant 2006;21:145-52.  Back to cited text no. 3
Gilles R, den Heijer M, Ross AH, Sweep FC, Hermus AR, Wetzels JF. Thyroid function in patients with proteinuria. Neth J Med 2008;66:483-5.  Back to cited text no. 4
Kaptein EM. Thyroid hormone metabolism and thyroid disease in chronic renal failure. Endocrin Rev 1996;17:45-63.  Back to cited text no. 5
Iglesias P, Diez JJ. Thyroid dysfunction and kidney disease. Eur Soc Endocrinol 2009;160:503-15.  Back to cited text no. 6
Malik AF. Evaluation of thyroid function in patients with chronic kidney disease. Iraq IJ Med Sci 2011;9:162-9.  Back to cited text no. 7
Rajagopalan B, Pragna B, Dolia, et al. Renal function markers and thyroid hormone status in undialyzed chronic kidney disease. Al Ameen J Med Sci 2013;6:70-4.  Back to cited text no. 8
Garrido-Magaña E, Heyser-Ortiz SE, AguilarKitsu A, et al. Thyroid dysfunction in children with chronic renal failure. Nefrologia 2009;29:449-55.  Back to cited text no. 9

Correspondence Address:
Dr. Wilma Delphine Silvia Chickballapur Rayappa
Department of Biochemistry, Akash Institute of Medical Sciences and Research Centre, Devanahalli, Bangalore -562110, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1319-2442.148749

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