Halilcevic Alma, Hodzic Emir, Mesic Enisa, Trnacevic Senaid
Clinic for Internal Diseases of University Clinical Center Tuzla, Department of Nephrology, Dialysis and Transplantation, Tuzla, Bosnia and Herzegovina.
Mater Sociomed. 2015 Apr;27(2):108-11. doi: 10.5455/msm.2015.27.4-108-111. Epub 2015 Apr 5.
Thyroid disorders are common in chronic kidney disease.
The purpose of this study was to compare thyroid gland disorders among healthy participants and renal transplant patients and to assess the duration of dialysis on thyroid disorders before transplantation.
Prospective study during 12 months period included 80 participants divided into two groups. Study group of 40 patients with transplanted kidney was divided in two subgroups, according to the time spent on dialysis (i.e. under and over 72 months). The control group included 40 healthy participants. The exclusion criteria was represented by the previous thyroid disorders and systemic illnesses and treatment with drugs that interfere with thyroid function (amiodarone, propranolol, lithium). The blood samples were taken for standard laboratory analysis, total thyroid hormone levels. Serum level of free thyroxine (T4) and free triiodothyronine (T3) were assayed by RIA using commercially available kits. Subclinical hypothyroidism is defined by the finding of elevated thyroid-stimulating hormone (TSH) > 4.4 mmol/L and normal values of T3 and T4.
The relative distribution of the functional thyroid disorders is statistically significantly higher in the experimental group: the low T3 syndrome in 12.5% (n = 5) patients (p = 0.017); low T4 syndrome in 7.5% (n = 3) patients (p = 0.072) and subclinical hypothyroidism in 17.5% (n = 7) patients (p = 0.021). There is statistically significant difference in the relative representation (percentage) between respondents to 72 months and respondents over 72 months duration of hemodialysis, namely: low T3 syndrome, which is a higher percentage was recorded in patients up to 72 months duration of dialysis (19.23%), then subclinical hypothyroidism where a greater percentage recorded in subjects over 72 months duration of dialysis (35.71%) before transplantation.
Considering that we are found in kidney transplant patients a significant link of subclinical hypothyroidism with decreased level of T3 and higher incidence of low T3 syndrome, which are associated with increased cardiovascular mortality and morbidity, and act as markers of survival patients after transplantation, it is necessary to conduct a periodically measuring levels of T3, T4 and TSH in these patients in order to assess the relationship between thyroid dysfunction and mortality risk in this population.
甲状腺疾病在慢性肾脏病中很常见。
本研究的目的是比较健康参与者和肾移植患者的甲状腺疾病情况，并评估移植前透析时间对甲状腺疾病的影响。
为期12个月的前瞻性研究纳入了80名参与者，分为两组。40例肾移植患者的研究组根据透析时间（即72个月以下和72个月以上）分为两个亚组。对照组包括40名健康参与者。排除标准为既往有甲状腺疾病、全身性疾病以及使用干扰甲状腺功能的药物（胺碘酮、普萘洛尔、锂）治疗。采集血样进行标准实验室分析，检测总甲状腺激素水平。采用市售试剂盒通过放射免疫分析法测定血清游离甲状腺素（T4）和游离三碘甲状腺原氨酸（T3）水平。亚临床甲状腺功能减退的定义为甲状腺刺激激素（TSH）>4.4 mmol/L且T3和T4值正常。
实验组功能性甲状腺疾病的相对分布在统计学上显著更高：低T3综合征在12.5%（n = 5）的患者中出现（p = 0.017）；低T4综合征在7.5%（n = 3）的患者中出现（p = 0.072），亚临床甲状腺功能减退在17.5%（n = 7）的患者中出现（p = 0.021）。透析时间72个月及以下的患者与透析时间超过72个月的患者在相对比例（百分比）上存在统计学显著差异，即：低T3综合征在透析时间达72个月及以下的患者中比例更高（19.23%），而亚临床甲状腺功能减退在透析时间超过72个月的患者中比例更高（35.71%），均在移植前。
鉴于我们发现肾移植患者中亚临床甲状腺功能减退与T3水平降低以及低T3综合征的发生率较高存在显著关联，而这些与心血管疾病死亡率和发病率增加相关，并作为移植后患者生存的标志物，有必要定期测量这些患者的T3、T4和TSH水平，以评估该人群中甲状腺功能障碍与死亡风险之间的关系。
