Fonseca V, Thomas M, Katrak A, Sweny P, Moorhead J F
Royal Free Hospital, London, UK.
Lancet. 1991 Aug 24;338(8765):475-6. doi: 10.1016/0140-6736(91)90546-2.
Four patients presented with nephrotic syndrome associated with hypothyroidism; none had thyroid antibodies. Hypothyroidism resolved on remission of nephrotic syndrome in two patients; thyroxine (T4) replacement was ineffective during periods of gross proteinuria in another, and the fourth had had normal thyroid function a year before presentation. Urinary T4 excretion was measured in ten further patients with proteinuria. It was detectable in the urine in five, who had significantly lower serum free T4 (8.5 [95% confidence interval 5.8-11.2] vs 13.9 [11.1-16.7] pmol/l; p less than 0.01) and free triiodothyronine (3.1 [2.2-4.0] vs 4.9 [3.8-6.0] pmol/l; p less than 0.01) concentrations than the five patients without detectable urinary T4.
4例患者表现为肾病综合征合并甲状腺功能减退；均无甲状腺抗体。2例患者甲状腺功能减退在肾病综合征缓解后消失；另1例在大量蛋白尿期间补充甲状腺素（T4）无效，第4例在就诊前1年甲状腺功能正常。另外10例蛋白尿患者测定了尿T4排泄量。5例患者尿中可检测到T4，其血清游离T4（8.5[95%可信区间5.8 - 11.2]对13.9[11.1 - 16.7]pmol/L；p<0.01）和游离三碘甲状腺原氨酸（3.1[2.2 - 4.0]对4.9[3.8 - 6.0]pmol/L；p<0.01）浓度显著低于尿中未检测到T4的5例患者。
