Benido Silva Vânia, Pereira Maria Teresa, Moreira Carla Leal, Santos Monteiro Sílvia, Inácio Isabel, Cardoso Maria Helena
Department of Endocrinology, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
Department of Nephrology, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
Case Rep Endocrinol. 2021 Aug 30;2021:5523929. doi: 10.1155/2021/5523929. eCollection 2021.
Nephrotic syndrome may trigger the onset of hypothyroidism, promoting massive urinary protein losses including thyroxine (T4) and triiodothyronine (T3) along with their binding proteins. At an early stage, a clinical and biochemical euthyroid state is expected. However, in patients with prolonged and severe proteinuria, especially with concomitant low thyroid reserve, urinary losses of free and protein-bound thyroid hormones are sufficiently pronounced to induce a subclinical or overt hypothyroidism. Despite its high prevalence in clinical practice, the literature lacks case reports of newly diagnosed clinical hypothyroidism due to NS in adults, making this condition under-recognized. We report a case of a 23-year-old man with previous normal thyroid function who developed overt hypothyroidism due to a severe nephrotic syndrome, requiring supplementation with levothyroxine (LT). After the patient had undergone bilateral nephrectomy, treatment with LT was discontinued and thyroid function normalized.
肾病综合征可能引发甲状腺功能减退症的发作，促使包括甲状腺素（T4）和三碘甲状腺原氨酸（T3）及其结合蛋白在内的大量尿蛋白丢失。在早期阶段，预计会出现临床和生化甲状腺功能正常状态。然而，在长期和严重蛋白尿的患者中，尤其是伴有甲状腺储备低的患者，游离和与蛋白结合的甲状腺激素的尿丢失足够明显，可导致亚临床或显性甲状腺功能减退症。尽管其在临床实践中患病率很高，但文献中缺乏成人因肾病综合征新诊断出临床甲状腺功能减退症的病例报告，使得这种情况未得到充分认识。我们报告一例23岁男性病例，该患者既往甲状腺功能正常，因严重肾病综合征发展为显性甲状腺功能减退症，需要补充左甲状腺素（LT）。患者接受双侧肾切除术后，停用LT治疗，甲状腺功能恢复正常。
