Łebkowska U, Malyszko J, Myśliwiec M
Department of Radiology, Medical University, Zurawia 14, 15-540 Bialystok, Poland.
Transplant Proc. 2003 Dec;35(8):2945-8. doi: 10.1016/j.transproceed.2003.10.066.
Disturbances in thyroid function are common among patients on renal replacement therapy. The aim of the present study was to compare thyroid stimulating hormone (TSH) and thyroid morphology among patients on hemodialysis (HD), peritoneal dialysis (CAPD), and after kidney transplantation. The study was performed on three groups of patients: 48 transplant recipients (Tx) (receiving cyclosporine, azathioprine, and prednisone); 32 HD, and 26 CAPD patients. The control group included 40 healthy volunteers. Thyroid examinations were performed with a 7.5-MHz probe and the thyroid volume was calculated. Among Tx patients the thyroid volume was 25.16 +/- 12.27mL; 21.60 +/- 10.33mL in HD; 19.70 +/- 8.46 mL in CAPD; and 16.34 +/- 5.46mL in the healthy volunteers. Serum TSH was within the normal range in each group. Goiter was diagnosed in the majority of Tx, most HD patients, and some CAPD patients. Single and multiple nodules were found in 21 Tx, 12 HD, and 2 CAPD patients. Moreover, parathyroid glands were visualized on sonography in 10 Tx, 12 HD, and 8 CAPD subjects. In Tx observed correlations were positive between thyroid volume and creatinine, negative between thyroid volume and TSH. The time after transplantation correlated negatively with TSH. No correlation between TSH, thyroid volume, and time on dialysis was observed. The prevalence in patients on renal replacement therapy was higher than that in the general population. These findings suggest that screening for abnormal thyroid morphology should be performed in kidney patients and that iodide supplementation should be considered in Tx patients.
甲状腺功能紊乱在接受肾脏替代治疗的患者中很常见。本研究的目的是比较血液透析（HD）、腹膜透析（CAPD）患者以及肾移植后患者的促甲状腺激素（TSH）和甲状腺形态。该研究对三组患者进行：48名移植受者（Tx）（接受环孢素、硫唑嘌呤和泼尼松）；32名HD患者和26名CAPD患者。对照组包括40名健康志愿者。使用7.5MHz探头进行甲状腺检查并计算甲状腺体积。Tx患者的甲状腺体积为25.16±12.27mL；HD患者为21.60±10.33mL；CAPD患者为19.70±8.46mL；健康志愿者为16.34±5.46mL。每组患者的血清TSH均在正常范围内。大多数Tx患者、多数HD患者和部分CAPD患者被诊断为甲状腺肿。21名Tx患者、12名HD患者和2名CAPD患者发现了单个和多个结节。此外，在10名Tx患者、12名HD患者和8名CAPD患者的超声检查中可见甲状旁腺。在Tx患者中，观察到甲状腺体积与肌酐之间呈正相关，甲状腺体积与TSH之间呈负相关。移植后的时间与TSH呈负相关。未观察到TSH、甲状腺体积与透析时间之间的相关性。肾脏替代治疗患者的患病率高于普通人群。这些发现表明，应对肾病患者进行甲状腺形态异常筛查，并且应考虑对Tx患者补充碘。
