Ito S, Kano K, Ando T, Ichimura T
First Department of Paediatrics, Dokkyo University School of Medicine, Tochigi, Japan.
Pediatr Nephrol. 1994 Aug;8(4):412-5. doi: 10.1007/BF00856516.
The thyroid function of seven children with untreated nephrotic syndrome who had a normal serum creatinine concentration was compared with that of the same patients in remission and age-matched controls. There was a significant decrease in serum thyroxine (T4), tri-iodothyronine (T3) and thyroid-binding globulin (TBG) concentrations in untreated nephrotic children compared with the same patients in remission and age-matched controls. Most values for serum free T4, free T3 and thyroid-stimulating hormone (TSH) in the patients with nephrosis were within the normal range. However, the mean serum free T4 and free T3 concentrations were significantly (P < 0.05) lower in the untreated patients than in the same patients in remission, and the mean serum TSH concentrations were significantly (P < 0.05) higher in the untreated patients than in the same patients in remission. There were massive urinary losses of T4, T3, TBG, free T4 and free T3 in the untreated nephrotic children compared with the same patients in remission and age-matched controls. The daily urinary protein excretion showed a positive correlation with the urinary T4, T3, free T4, free T3 and TBG excretion. Furthermore, the urinary protein excretion showed a negative correlation with the serum T4, T3, free T4, free T3 and TBG levels. There was a negative correlation between serum albumin and serum TSH. These findings provide evidence of mild hypothyroidism in children with untreated nephrotic syndrome, partly because of losses of T4, T3, free T4, free T3 and TBG into the urine.
对7名血清肌酐浓度正常但未经治疗的肾病综合征患儿的甲状腺功能，与其缓解期时的自身情况以及年龄匹配的对照组进行了比较。与缓解期时的自身情况及年龄匹配的对照组相比，未经治疗的肾病患儿血清甲状腺素（T4）、三碘甲状腺原氨酸（T3）和甲状腺结合球蛋白（TBG）浓度显著降低。肾病患儿血清游离T4、游离T3和促甲状腺激素（TSH）的大多数值在正常范围内。然而，未经治疗的患儿血清游离T4和游离T3的平均浓度显著低于（P < 0.05）缓解期时的自身情况，而未经治疗的患儿血清TSH的平均浓度显著高于（P < 0.05）缓解期时的自身情况。与缓解期时的自身情况及年龄匹配的对照组相比，未经治疗的肾病患儿存在大量T4、T3、TBG、游离T4和游离T3的尿中丢失。每日尿蛋白排泄量与尿中T4、T3、游离T4、游离T3和TBG排泄量呈正相关。此外，尿蛋白排泄量与血清T4、T3、游离T4、游离T3和TBG水平呈负相关。血清白蛋白与血清TSH之间存在负相关。这些发现为未经治疗的肾病综合征患儿存在轻度甲状腺功能减退提供了证据，部分原因是T4、T3、游离T4、游离T3和TBG经尿液丢失。
