Baajafer F S, Hammami M M, Mohamed G E
Department of Medicine, King Faisal Specialist Hospital and Research Centre Riyadh, Saudi Arabia.
J Endocrinol Invest. 1999 Jan;22(1):35-9. doi: 10.1007/BF03345476.
Hypothyroidism is widely accepted as a cause of hyponatremia and hypercreatininemia. However, the prevalence and severity of hyponatremia and hypercreatininemia in hypothyroid patients without comorbid conditions have not been well documented. We retrospectively studied serum sodium and creatinine levels in thyroid-ablated patients with differentiated thyroid cancer off (no.=128) and on (no.=60) thyroid hormone therapy. In the hypothyroid state, mean(+/-SD) TSH, sodium, and creatinine levels were 130.3+/-104.8 mU/l, 139.3+/-2.7 mEq/l, and 89.4+/-20 mmol/l respectively. Twenty-four patients (18.8%) had creatinine levels above the age- and sex-adjusted normal range, whereas only five patients (3.9%) had sodium levels below 135 mEq/l. No patient had a sodium level less than 130 mEq/l. Compared to their euthyroid values, mean sodium and creatinine levels of the hypothyroid patients changed by -1.18 mEq/l (p=0.003) and 17.2 mmol/l (p<0.0001), respectively. There was significant correlation of TSH levels in the hypothyroid state with the changes from the euthyroid state to the hypothyroid state in creatinine levels (r=0.29, p=0.02) but not with the corresponding changes in sodium levels (r=0.06, p=0.6). In thirty-seven patients studied in two hypothyroid episodes, there was a significant correlation between a) TSH levels in hypothyroid state 1 and hypothyroid state 2 (r=0.56, p=0.0003), and b) the change in creatinine levels from the euthyroid state to hypothyroid state 1 and the corresponding change from the euthyroid state to hypothyroid state 2 (r=0.48, p=0.003). There was no significant correlation between the change in sodium levels from the euthyroid state to hypothyroid state 1 and the corresponding change from the euthyroid state to hypothyroid state 2 (r=0.32, p=0.05). We conclude that hyponatremia is very uncommon, whereas mild to moderate elevation in serum creatinine level is not uncommon in patients with short-term uncomplicated hypothyroidism.
甲状腺功能减退被广泛认为是低钠血症和血肌酐升高的一个原因。然而，在没有合并症的甲状腺功能减退患者中，低钠血症和血肌酐升高的患病率及严重程度尚未得到充分记录。我们回顾性研究了接受甲状腺切除的分化型甲状腺癌患者在停用（n = 128）和使用（n = 60）甲状腺激素治疗时的血清钠和肌酐水平。在甲状腺功能减退状态下，促甲状腺激素（TSH）、钠和肌酐水平的均值（±标准差）分别为130.3±104.8 mU/l、139.3±2.7 mEq/l和89.4±20 mmol/l。24例患者（18.8%）的肌酐水平高于年龄和性别校正后的正常范围，而只有5例患者（3.9%）的钠水平低于135 mEq/l。没有患者的钠水平低于130 mEq/l。与甲状腺功能正常时的值相比，甲状腺功能减退患者的平均钠和肌酐水平分别变化了 -1.18 mEq/l（p = 0.003）和17.2 mmol/l（p < 0.0001）。甲状腺功能减退状态下的TSH水平与从甲状腺功能正常状态到甲状腺功能减退状态时肌酐水平的变化显著相关（r = 0.29，p = 0.02），但与钠水平的相应变化无关（r = 0.06，p = 0.6）。在37例经历两次甲状腺功能减退发作的患者中，a）甲状腺功能减退状态1和甲状腺功能减退状态2时的TSH水平之间（r = 0.56，p = 0.0003），以及b）从甲状腺功能正常状态到甲状腺功能减退状态1时肌酐水平的变化与从甲状腺功能正常状态到甲状腺功能减退状态2时的相应变化之间（r = 0.48，p = 0.003）存在显著相关性。从甲状腺功能正常状态到甲状腺功能减退状态1时钠水平的变化与从甲状腺功能正常状态到甲状腺功能减退状态2时的相应变化之间没有显著相关性（r = 0.32，p = 0.05）。我们得出结论，低钠血症非常少见，而在短期无并发症的甲状腺功能减退患者中，血清肌酐水平轻度至中度升高并不少见。
