Dubczak Iwanna, Niemczyk Longin, Bartoszewicz Zbigniew, Szamotulska Katarzyna, Saracyn Marek, Niemczyk Stanisław
Department of Internal Medicine, Nephrology and Dialysis, Central Clinical Hospital of the Ministry of Defence, Military Institute of Medicine in Warsaw, Poland.
Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Poland.
Pol Merkur Lekarski. 2017 Mar 21;42(249):101-105.
Hypothyroidism in patients with renal failure (RF) causes many metabolic and clinical problems, and both these diseases can mutually exacerbate their disturbances.
The aim of this study was to evaluate the effect of hypothyroidism, and end-stage renal disease (ESRD) on conversion of thyroid hormones (TH) in patients with ESRD treated with chronic hemodialysis (HD).
The study was performed in 74 patients, including 41 women (K) and 33 men (M) aged 28-83 y.o. in 4 groups: G1 - 12 people with ESRD treated with HD and with newly diagnosed hypothyroidism without substitution (6 K and M 6) aged 66,83±12,90 y.o., G2 - 26 patients with ESRD treated with HD without hypothyroidism (10 F, 16 M) aged 58,85±15,52 y.o., G3 - 11 hypothyroid patients without RF (9 K, 2 M) aged 54,73±21,26 y.o., G4 - 25-persons from control group of healthy subjects (16 M, 9 M) aged 51,24±12,58 y.o. In all subjects the concentration of TSH and TH (T4, T3, fT4, TSH, FT3, rT3) were measured and values of conversion factors (T3/T4, FT3/ fT4, rT3/fT4 and rT3/fT3) and binding TH to protein factors (fT4/T4 and fT3/T3) were calculated.
Lower concentration of T3 (p=0.012), fT3 (p<0.001) i fT4 (p=0.014) was found in patients without hypothyroidism than in healthy subjects. Renal failure with concomitant hypothyroidism intensify the disturbances of T4 to T3 conversion (p=0.034) and hypothyroidism with concomitant renal failure disrupts binding of T3 to proteins (p=0.001). FT3 to fT4 ratio in renal failure with concomitant hypothyroidism group was significantly lower than in each other group. rT3 concentrations were the highest in healthy subjects.
Concomitance of hypothyroidism and end-stage renal disease reduces the conversion of thyroxine to triiodothyronine, but does not increase the production of rT3. Hypothyroidism significantly increases the disorders of thyroid hormones in end-stage renal disease. There is decreased tendency to bind of thyroid hormone to protein in hypothyroidism in patients with end-stage renal disease.
肾衰竭（RF）患者的甲状腺功能减退会引发许多代谢和临床问题，且这两种疾病会相互加剧对方的紊乱情况。
本研究旨在评估甲状腺功能减退和终末期肾病（ESRD）对接受慢性血液透析（HD）治疗的ESRD患者甲状腺激素（TH）转化的影响。
该研究纳入了74例患者，包括41名女性（K）和33名男性（M），年龄在28 - 83岁，分为4组：G1组 - 12例接受HD治疗且新诊断为甲状腺功能减退但未进行替代治疗的ESRD患者（6名女性和6名男性），年龄66.83±12.90岁；G2组 - 26例接受HD治疗且无甲状腺功能减退的ESRD患者（10名女性，16名男性），年龄58.85±15.52岁；G3组 - 11例无肾衰竭的甲状腺功能减退患者（9名女性，2名男性），年龄54.73±21.26岁；G4组 - 25名来自健康受试者对照组的人员（16名男性，9名女性），年龄51.24±12.58岁。测量了所有受试者的促甲状腺激素（TSH）和TH（T4、T3、游离T4、TSH、游离T3、反T3）浓度，并计算了转化因子值（T3/T4、游离T3/游离T4、反T3/游离T4和反T3/游离T3）以及TH与蛋白质结合因子（游离T4/T4和游离T3/T3）。
未患甲状腺功能减退的患者中，T3（p = 0.012）、游离T3（p < 0.001）和游离T4（p = 0.014）的浓度低于健康受试者。伴有甲状腺功能减退的肾衰竭会加剧T4向T3转化的紊乱（p = 0.034），而伴有肾衰竭的甲状腺功能减退会破坏T3与蛋白质的结合（p = 0.001）。伴有甲状腺功能减退的肾衰竭组中游离T3与游离T4的比值显著低于其他各组。反T3浓度在健康受试者中最高。
甲状腺功能减退与终末期肾病并存会降低甲状腺素向三碘甲状腺原氨酸的转化，但不会增加反T3的产生。甲状腺功能减退会显著加剧终末期肾病患者甲状腺激素的紊乱。终末期肾病患者甲状腺功能减退时，甲状腺激素与蛋白质结合的趋势降低。
