Cotoi Laura, Borcan Florin, Sporea Ioan, Amzar Daniela, Schiller Oana, Schiller Adalbert, Dehelean Cristina A, Pop Gheorghe Nicusor, Borlea Andreea, Stoian Dana
PhD School Department, "Victor Babes" University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania.
Analytical Chem. and Toxicology Department, "Victor Babes" University of Medicine and Pharmacy Timisoara, 2nd Eftimie Murgu Square, 300041 Timisoara, Romania.
Diagnostics (Basel). 2020 Apr 23;10(4):245. doi: 10.3390/diagnostics10040245.
Chronic kidney disease is a rising cause of morbidity and mortality in developed countries, including end-stage renal disease (ESRD). The prevalence of thyroid comorbidities in persons with chronic kidney disease is documented higher than in normal population. The study aims to investigate the prevalence of morphological and functional thyroid disorders in patients with chronic kidney disease, with renal replacement therapy (hemodialysis).
A cross-sectional study was performed on 123 consecutive patients with chronic kidney disease stage 5, on hemodialysis during a period of one month (May 2019-June 2020). All patients were enrolled for maintenance hemodialysis in B Braun Hemodialysis Center Timisoara and were examined on conventional 2B ultrasound. Thyroid blood tests were done, including serum free thyroxin (FT4), free triiodothyronine (FT3) and thyroid-stimulating hormone (TSH) at the time of starting hemodialysis.
We evaluated 123 patients (male to female ratio 70/53) mean age 62.2 ± 11.01, mostly above 65 years old, enrolled in the end-stage renal disease program, on renal replacement therapy. From the cohort, 76/123 presented thyroid disease, including autoimmune hypothyroidism, nodular goiter or thyroid cancer. Among them, 63 patients presented nodular goiter, including 3 thyroid cancers, confirmed by surgery and histopathological result, 22 patients had thyroid autoimmune disease. The serum thyroid-stimulating hormone levels found in the cohort was 3.36 ± 2.313 mUI/mL, which was in the normal laboratory reference range. The thyroid volume was 13 ± 7.18 mL. A single patient in the cohort presented Graves Basedow disease, under treatment and three patients present subclinical hyperthyroidism. We have found that thyroid disease risk is increased by 3.4-fold for the female gender and also the increase of body mass index (BMI) with one unit raises the risk of developing thyroid disease with 1.083 times ( = 0.018).
To conclude, this study aimed to quantify the prevalence of thyroid disease in end-stage kidney disease population, especially nodular goiter, important for differential diagnosis in cases with secondary hyperparathyroidism. Thyroid autoimmune disease can be prevalent among these patients, as symptoms can overlap those of chronic disease and decrease the quality of life. We have found that thyroid disease has a high prevalence among patients with end-stage renal disease on hemodialysis. Thyroid goiter and nodules in ESRD patients were more prevalent than in the general population. Clinical surveillance and routine screening for thyroid disorders can improve the quality of life in these patients.
在包括终末期肾病（ESRD）在内的发达国家，慢性肾脏病导致的发病率和死亡率不断上升。有记录表明，慢性肾脏病患者中甲状腺合并症的患病率高于正常人群。本研究旨在调查接受肾脏替代治疗（血液透析）的慢性肾脏病患者中形态学和功能性甲状腺疾病的患病率。
对连续123例慢性肾脏病5期患者进行了一项横断面研究，这些患者在1个月期间（2019年5月至2020年6月）接受血液透析。所有患者均在蒂米什瓦拉的贝朗血液透析中心登记接受维持性血液透析，并接受常规2B超声检查。在开始血液透析时进行甲状腺血液检查，包括血清游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）和促甲状腺激素（TSH）。
我们评估了123例患者（男女比例为70/53），平均年龄62.2±11.01岁，大多超过65岁，参加了终末期肾病项目并接受肾脏替代治疗。在该队列中，76/123例患有甲状腺疾病，包括自身免疫性甲状腺功能减退症、结节性甲状腺肿或甲状腺癌。其中，63例患者患有结节性甲状腺肿，包括3例经手术和组织病理学结果证实的甲状腺癌，22例患者患有甲状腺自身免疫性疾病。该队列中血清促甲状腺激素水平为3.36±2.313mUI/mL，在实验室正常参考范围内。甲状腺体积为13±7.18mL。队列中有1例患者患有格雷夫斯病，正在接受治疗，3例患者患有亚临床甲状腺功能亢进症。我们发现，女性患甲状腺疾病的风险增加3.4倍，体重指数（BMI）每增加一个单位，患甲状腺疾病的风险增加1.083倍（=0.018）。
总之，本研究旨在量化终末期肾病患者中甲状腺疾病的患病率，尤其是结节性甲状腺肿，这对于继发性甲状旁腺功能亢进症病例的鉴别诊断很重要。甲状腺自身免疫性疾病在这些患者中可能很普遍，因为其症状可能与慢性疾病的症状重叠并降低生活质量。我们发现，接受血液透析的终末期肾病患者中甲状腺疾病的患病率很高。ESRD患者中的甲状腺肿和结节比普通人群中更普遍。对甲状腺疾病进行临床监测和常规筛查可以改善这些患者的生活质量。
