[肾病综合征：勿忘筛查甲状腺功能减退症]

[Nephrotic syndrome: don't forget to search for hypothyroidism].

作者信息

Trouillier S, Delèvaux I, Rancé N, André M, Voinchet H, Aumaître O

机构信息

Service de médecine interne, CHU Gabriel-Montpied, 58, rue Montalembert, B.P. 69, 63001 Clermont-Ferrand cedex, France.

出版信息

Rev Med Interne. 2008 Feb;29(2):139-44. doi: 10.1016/j.revmed.2007.10.412. Epub 2007 Nov 20.

DOI:10.1016/j.revmed.2007.10.412

PMID:18191306

Abstract

INTRODUCTION

If abnormal thyroid function indices have been reported in patients with nephrotic syndrome, hypothyroidism is exceptional.

EXEGESIS

We report three adult patients (1, 2, 3) with hypothyroidism associated with nephrotic syndrome (minimal change glomerulonephritis [1], idiopathic membranous nephropathy stage I [2], stage II [3]). Glomerulopathy treatment and thyroid hormone replacement therapy were both initiated. Low replacement (1, 2) was sufficient when proteinuria decreased. It was higher when nephrotic syndrome was uncontrolled (3).

CONCLUSION

Excessive thyroxine-binding protein and thyroxine urinary loss generate low rate of free thyroxine and elevated TSH. Systematic thyroid hormonal test is necessary if nephrotic syndrome is severe and prolonged.

摘要

引言

如果在肾病综合征患者中报告了甲状腺功能指标异常，甲状腺功能减退是罕见的。

释义

我们报告了3例成年患者（病例1、2、3），他们患有与肾病综合征相关的甲状腺功能减退（微小病变性肾小球肾炎[病例1]、特发性膜性肾病I期[病例2]、II期[病例3]）。同时启动了肾小球病治疗和甲状腺激素替代治疗。当蛋白尿减少时，低剂量替代治疗（病例1、2）就足够了。当肾病综合征未得到控制时（病例3），替代剂量则更高。