甲状腺功能障碍与肾功能：一种需要认识的关键关系。
Thyroid Dysfunction and Renal Function: A Crucial Relationship to Recognize.
作者信息
Naguib Rania, Elkemary Eman
机构信息
Internal Medicine Department, Endocrinology Unit, Faculty of Medicine, Alexandria University, Alexandria, EGY.
Clinical Pathology Department, Faculty of Medicine, Alexandria University, Alexandria, EGY.
出版信息
Cureus. 2023 Feb 20;15(2):e35242. doi: 10.7759/cureus.35242. eCollection 2023 Feb.
BACKGROUND AND AIM
Renal function is noticeably altered in both hypothyroidism and hyperthyroidism. However, clinical studies on thyroid dysfunction and its association with renal function are scarce. The purpose of this study was to evaluate changes in biochemical parameters of renal function in subjects with thyroid dysfunction and to correlate these values with the patient's thyroid profile. The effect of changes in thyroid function during therapy on renal function was also investigated.
METHODS
A prospective cohort study included 41 patients with untreated primary hypothyroidism and 16 patients with untreated hyperthyroidism. Thyroid-stimulating hormone (TSH), free thyroxine, and free triiodothyronine were assessed using immunoassay. The estimated glomerular filtration rate was calculated by the Modification of Diet in Renal Disease formula. Renal function tests were assessed in all patients at each of the two-time points: during thyroid dysfunction (hypo- or hyperthyroidism) and after attaining euthyroidism.
RESULTS
Our study demonstrated a statistically significant reduction in the average serum creatinine level in the hypothyroid patients after treatment compared to before treatment whereas the mean estimated glomerular filtration rate (eGFR) significantly improved after treatment compared to before treatment. Moreover, the average serum creatinine level in the hyperthyroid patients was significantly lower before treatment compared to after treatment, whereas the mean eGFR significantly dropped after treatment. TSH had a significant positive correlation with serum creatinine and a significant negative correlation with eGFR in all patients with thyroid dysfunction.
CONCLUSIONS
Thyroid dysfunction is associated with deranged kidney function. It is crucial for the clinician to be aware of the link between thyroid disorders and aberrant renal function in order to consider a thyroid function test when treating a patient whose biochemical markers of renal function are only mildly elevated. There is a need for monitoring creatinine in patients with thyroid dysfunction.
背景与目的
甲状腺功能减退和甲状腺功能亢进时肾功能均会出现显著改变。然而，关于甲状腺功能障碍及其与肾功能关系的临床研究较少。本研究旨在评估甲状腺功能障碍患者肾功能生化参数的变化，并将这些值与患者的甲状腺指标相关联。还研究了治疗期间甲状腺功能变化对肾功能的影响。
方法
一项前瞻性队列研究纳入了41例未经治疗的原发性甲状腺功能减退患者和16例未经治疗的甲状腺功能亢进患者。采用免疫分析法评估促甲状腺激素（TSH）、游离甲状腺素和游离三碘甲状腺原氨酸。采用肾脏病饮食改良公式计算估算肾小球滤过率。在两个时间点的每一个时间点对所有患者进行肾功能测试：甲状腺功能障碍（甲状腺功能减退或亢进）期间以及甲状腺功能正常后。
结果
我们的研究表明，与治疗前相比，甲状腺功能减退患者治疗后平均血清肌酐水平有统计学意义的降低，而平均估算肾小球滤过率（eGFR）与治疗前相比有显著改善。此外，与治疗后相比，甲状腺功能亢进患者治疗前平均血清肌酐水平显著降低，而平均eGFR治疗后显著下降。在所有甲状腺功能障碍患者中，TSH与血清肌酐呈显著正相关，与eGFR呈显著负相关。
结论
甲状腺功能障碍与肾功能紊乱有关。临床医生必须意识到甲状腺疾病与异常肾功能之间的联系，以便在治疗肾功能生化指标仅轻度升高的患者时考虑进行甲状腺功能检查。甲状腺功能障碍患者需要监测肌酐。
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