The influence of hypothyroidism and substitution treatment on thyroid hormone conversion ratios and rT3 concentration in patients with end-stage renal failure
Abstract
Introduction: The increasing number of patients with end-stage renal disease (ESRD) requires seeking new opportunities to improve their quality of life, not only because of kidney disease but also due to other disturbances, such as thyroid hormone disorders. The objective of the study was to evaluate the influence of coexisting hypothyroidism and thyroid hormone therapy in patients with ESRD on thyroid hormone conversion ratios and rT3 concentration.
Material and methods: The study involved 85 patients aged 26 to 87 years, with a mean age of 59.62 ± 15.45 years. Four groups of patients were examined: G1 group — 25 persons without RF and hypothyroidism, G2 — 26 patients with ESRD treated with haemodialysis (HD), G3 — 12 patients with ESRD treated with HD and newly diagnosed hypothyroidism, and G4 — 22 HD patients with hypothyroidism treated with thyroid hormones substitution. The concentrations of TSH, T4, T3, fT4, fT3, and rT3 were measured and the fT3/fT4, T3/T4, and rT3/T4 conversion ratios and rT3/T3 ratio were calculated. Concentrations of protein, hsCRP, Hg, and blood gases were also checked; the anion gap was calculated.
Results: Patients from group G1 through G2 to G3 were older (ptrend = 0.002), with lower Hb level (ptrend < 0.001), with lower pH (ptrend < 0.001), with increased anion gap (ptrend < 0.013) and CRP concentrations (ptrend < 0.001), and decreased total protein level (ptrend < 0.001). There were increased TSH values (ptrend < 0.001) and lower T4 (ptrend = 0.024), fT3 (ptrend < 0.001), T3 (ptrend < 0.001), and rT3 (ptrend = 0.008) levels. rT3/T3 ratio did not change, the rT3/T4 ratio tended to decrease (ptrend = 0.065) similarly to T3/T4 ratio (ptrend = 0.063), and the fT3/fT4 ratio also decreased (ptrend = 0.005). It seems that the treatment of thyroid disease in patients with renal failure, treated with haemodialysis, is not associated with change of rT3 and conversion factor levels.
Conclusions: The concentration of rT3 in HD patients in relation to healthy persons tends to decrease, and hypothyroidism increases this tendency in these patients. Hormone substitution treatment does not eliminate the influence of RF on inhibition of rT3 production. In patients with ESRD, hypothyroidism additionally reduces the conversion of thyroid hormones examined by fT3/fT4 and to a lesser extent T3/T4 ratios.
Keywords: end-stage renal diseasethyroid hormone conversionhypothyroidismsubstitution treatmentrT3
References
- Singh S, Verma A, Aryal G, et al. Prevalence of thyroid hormone abnormalities in stage 5 chronic kidney disease: a tertiary care center study of Nepal. Int J Res Med Sci. 2016: 3929–3933.
- Dash HS. Thyroid Dysfunction in chronic kidney disease. Indian J Appl Res. 2016; 6: 348–349.
- Carrero JJ, Qureshi AR, Axelsson J, et al. Clinical and biochemical implications of low thyroid hormone levels (total and free forms) in euthyroid patients with chronic kidney disease. J Intern Med. 2007; 262(6): 690–701.
- Enia G, Panuccio V, Cutrupi S, et al. Subclinical hypothyroidism is linked to micro-inflammation and predicts death in continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant. 2007; 22(2): 538–544.
- Csako G, Zweig MH, Glickman J, et al. Direct and indirect techniques for free thyroxin compared in patients with nonthyroidal illness. I. Effect of free fatty acids. Clin Chem. 1989; 35(1): 102–109.
- Padhy S, Devi A. Evalution of thyroid hormone status in chronic renal failure. Int J Pharm Bio. 2014; 5: 171–175.
- Wiederkehr MR, Kalogiros J, Krapf R. Correction of metabolic acidosis improves thyroid and growth hormone axes in haemodialysis patients. Nephrol Dial Transplant. 2004; 19(5): 1190–1197.
- Majeed HM, Mazin MR. Association between chronic renal failure and thyroid hormone. Indian JAppl Res. 2016; 6: 348–349.
- Liewendahl K, Tikanoja S, Mähönen H, et al. Concentrations of iodothyronines in serum of patients with chronic renal failure and other nonthyroidal illnesses: role of free fatty acids. Clin Chem. 1987; 33(8): 1382–1386.
- Baur A, Bauer K, Jarry H, et al. Effects of proinflammatory cytokines on anterior pituitary 5'-deiodinase type I and type II. J Endocrinol. 2000; 167(3): 505–515.
- Peeters RP, Wouters PJ, van Toor H, et al. Serum 3,3',5'-triiodothyronine (rT3) and 3,5,3'-triiodothyronine/rT3 are prognostic markers in critically ill patients and are associated with postmortem tissue deiodinase activities. J Clin Endocrinol Metab. 2005; 90(8): 4559–4565.
- Niemczyk S, Sokalski A, Matuszkiewicz-Rowińska J, et al. Konwersja hormonalna T4 do T3 u chorych ze schyłkowa niewydolnością nerek (SNN). Nefrol Dial Pol. 2009; 13: 148–152.
- Peeters RP, Wouters PJ, Kaptein E, et al. Reduced activation and increased inactivation of thyroid hormone in tissues of critically ill patients. J Clin Endocrinol Metab. 2003; 88(7): 3202–3211.
- den Brinker M, Joosten KFM, Visser TJ, et al. Euthyroid sick syndrome in meningococcal sepsis: the impact of peripheral thyroid hormone metabolism and binding proteins. J Clin Endocrinol Metab. 2005; 90(10): 5613–5620.
- Zoccali C, Tripepi G, Cutrupi S, et al. Low triiodothyronine: a new facet of inflammation in end-stage renal disease. J Am Soc Nephrol. 2005; 16(9): 2789–2795.
- Rodrigues MCS, Santos GM, da Silva CA, et al. Thyroid hormone transport is disturbed in erythrocytes from patients with chronic renal failure on hemodialysis. Ren Fail. 2004; 26(4): 461–466.
- Singh AK, Raed A, Kari J. Endocrine complications of chronic kidney disease. In: Kimmel P, Rosenberg M. ed. Chronic Renal Disesae. Elsevier Academic Press, Cambridge 2015.
- Mohamedali M, Reddy Maddika S, Vyas A, et al. Thyroid disorders and chronic kidney disease. Int J Nephrol. 2014; 2014: 520281.
- Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev. 2008; 29(1): 76–131.
- Horáček J, Dusilová Sulková S, Kubišová M, et al. Thyroid hormone abnormalities in hemodialyzed patients: low triiodothyronine as well as high reverse triiodothyronine are associated with increased mortality. Physiol Res. 2012; 61(5): 495–501.
- van den Beld AW, Visser TJ, Feelders RA, et al. Thyroid hormone concentrations, disease, physical function, and mortality in elderly men. J Clin Endocrinol Metab. 2005; 90(12): 6403–6409.
- Dubczak I, Niemczyk L. Fizjologia hormonów tarczycy i przyczyny zaburzeń tarczycowych w przewlekłej niewydolności nerek. Nefrol Dial Pol. 2016; 20: 258–261.
- Forestier E, Vinzio S, Sapin R, et al. Increased reverse triiodothyronine is associated with shorter survival in independently-living elderly: the Alsanut study. Eur J Endocrinol. 2009; 160(2): 207–214.
- Niemczyk S, Matuszkiewicz-Rowińska J, Sokalski A, et al. Test czynnościowy TRH — TSH u chorych ze schyłkową niewydolnością nerek (SNN). Nefrol Dial Pol. 2008; 12: 176–180.
- Peeters RP, van der Geyten S, Wouters PJ, et al. Tissue thyroid hormone levels in critical illness. J Clin Endocrinol Metab. 2005; 90(12): 6498–6507.
- Niemczyk S. Zaburzenia czynności tarczycy oraz hiperprolaktynemia u chorych ze schyłkową niewydolnością nerek. Akademia Medyczna w Warszawie, Warszawa 2004.
