Karethimmaiah Hareeshababu, Sarathi Vijaya
Associate Professor, Department of Nephrology, Vydehi Institute of Medical Sciences and Research Center , Bengaluru, Karnataka, India .
Associate Professor, Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center , Bengaluru, Karnataka, India .
J Clin Diagn Res. 2016 Dec;10(12):OC10-OC12. doi: 10.7860/JCDR/2016/24046.8974. Epub 2016 Dec 1.
Nephrotic syndrome is a known cause of hypothyroidism; however, its effect on replacement doses of L-thyroxine in patients with primary hypothyroidism is not systematically studied.
The aim of the present study was to evaluate the effect of newly diagnosed nephrotic syndrome on the dose of L-thyroxine replacement in previously diagnosed patients with primary hypothyroidism who were on full, stable dose of L-thyroxine replacement for at least one year.
Patients with previously diagnosed primary hypothyroidism on stable and full (≥1.6μg/day) replacement dose of L-thyroxine for at least one year who developed newly diagnosed nephrotic syndrome were included in the study. Patients were evaluated with thyroid function tests at diagnosis and every 2-3months. Replacement doses of L-thyroxine were titrated by a single endocrinologist based on serum Thyroid Stimulating Hormone (TSH) level.
The study included nine patients with mean age of 42.77±9.61years. There was significant increase in TSH at diagnosis of nephrotic syndrome (8.16±2.82μIU/ml) when compared to the immediate past visit (2.08±0.7μIU/ml) and needed 17.6% increase in the replacement dose of L-thyroxine. At last follow-up four patients had remission of nephrotic syndrome and in them thyroid function tests improved with reduction in replacement dose of L-thyroxine by 15% whereas patients who did not achieve remission had required further increase in L-thyroxine dose by 19.1%.
Development of nephrotic syndrome significantly increases the need for L-thyroxine replacement dose in previously diagnosed primary hypothyroidism patients on full stable dose of L-thyroxine replacement.
肾病综合征是甲状腺功能减退症的已知病因；然而，其对原发性甲状腺功能减退症患者左甲状腺素替代剂量的影响尚未得到系统研究。
本研究旨在评估新诊断的肾病综合征对先前诊断为原发性甲状腺功能减退症且已接受至少一年稳定足量左甲状腺素替代治疗的患者左甲状腺素替代剂量的影响。
本研究纳入了先前诊断为原发性甲状腺功能减退症且已接受稳定足量（≥1.6μg/天）左甲状腺素替代治疗至少一年，后又新诊断为肾病综合征的患者。在诊断时以及之后每2 - 3个月对患者进行甲状腺功能检查。左甲状腺素的替代剂量由一名内分泌科医生根据血清促甲状腺激素（TSH）水平进行调整。
该研究纳入了9名患者，平均年龄为42.77±9.61岁。与上一次就诊时（2.08±0.7μIU/ml）相比，肾病综合征诊断时TSH显著升高（8.16±2.82μIU/ml），左甲状腺素替代剂量需要增加17.6%。在最后一次随访时，4名患者的肾病综合征缓解，他们的甲状腺功能检查有所改善，左甲状腺素替代剂量减少了15%，而未缓解的患者左甲状腺素剂量需要进一步增加19.1%。
肾病综合征的发生显著增加了先前诊断为原发性甲状腺功能减退症且已接受稳定足量左甲状腺素替代治疗的患者对左甲状腺素替代剂量的需求。
