Chadha V, Alon U S
Section of Pediatric Nephrology, The Children's Mercy Hospital, Kansas City, MO 64108, USA.
Pediatr Nephrol. 1999 Apr;13(3):209-11. doi: 10.1007/s004670050594.
A state of biochemical hypothyroidism is commonly seen in infants with congenital nephrotic syndrome (NS) and therefore the current recommendation is to place all patients with congenital NS on supplemental thyroid preparations. We report our experience in five children with congenital NS in whom thyroid supplementation was discontinued following bilateral nephrectomy and initiation of renal replacement therapy. Immediately after nephrectomy, thyroid function tests normalized, except serum thyroid-stimulating hormone (TSH) concentration, which initially rose, but normalized later. This observation supports the hypothesis that hypothyroidism in these patients is secondary to the chronic massive proteinuria and is not the result of a defect intrinsic to the thyroid gland itself. Abatement of massive proteinuria enables discontinuation of thyroid supplementation, and a transient rise in TSH in the early post-nephrectomy stage should be potentially expected.
先天性肾病综合征（NS）患儿中常见生化性甲状腺功能减退状态，因此目前的建议是让所有先天性NS患者服用甲状腺补充制剂。我们报告了5例先天性NS患儿的经验，这些患儿在双侧肾切除及开始肾脏替代治疗后停用了甲状腺补充剂。肾切除术后，除血清促甲状腺激素（TSH）浓度最初升高但随后恢复正常外，甲状腺功能测试均恢复正常。这一观察结果支持了以下假设：这些患者的甲状腺功能减退是继发于慢性大量蛋白尿，而非甲状腺自身内在缺陷所致。大量蛋白尿的减轻使得甲状腺补充剂可以停用，肾切除术后早期TSH的短暂升高应在预期之内。
