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High prevalence of subclinical hypothyroidism and nodular thyroid disease in patients on hemodialysis

2015; Wiley; Volume: 20; Issue: 1 Linguagem: Inglês

10.1111/hdi.12339

1542-4758

Ana Beatriz Brenner Affonso da Costa, C Pellizzari, Gisah Amaral de Carvalho, Beatriz C. Sant'Anna, Rafaela L. Montenegro, Roberto G. Zammar Filho, Cléo Otaviano Mesa, Patrícia R. Hauck Prante, Márcia Olandoski, Maurício Carvalho,

Parathyroid Disorders and Treatments

Abstract Chronic kidney disease has been known to affect thyroid hormone metabolism. Low serum levels of T 3 and T 4 are the most remarkable laboratorial findings. A high incidence of goiter and nodules on thyroid ultrasonography has been reported in patients with end‐stage renal disease ( ESRD ). Our objective is to evaluate the prevalence of laboratorial and morphologic alterations in the thyroid gland in a cohort of patients with ESRD on hemodialysis ( HD ). Sixty‐one patients with ESRD on HD were selected and compared with 43 healthy subjects matched by age, gender, and weight. Patients were submitted to thyroid ultrasonography. T 3, free T 4 ( FT 4), thyroid‐stimulating hormone, antithyroglobulin, and antithyroperoxidase antibodies were measured. The mean age of patients with ESRD was 47.4 ± 12.3 and 61% were women. ESRD was mainly caused by hypertensive nephrosclerosis and diabetic nephropathy. Mean thyroid volume, as determined by ultrasonography, was similar in both groups. Patients with ESRD had more hypoechoic nodules when compared with the control group (24.1% vs. 7.9%, P = 0.056). Mean serum FT 4 and T 3 levels were significantly lower in patients with ESRD , and subclinical hypothyroidism was more prevalent in patients with ESRD (21.82% vs. 7.14% control group, P = 0.04). Titers of antithyroid antibodies were similar in both groups. ESRD was associated with a higher prevalence of subclinical hypothyroidism and lower levels of T 3 and FT 4. Almost a quarter of patients showed thyroid nodules >10 mm. Periodic ultrasound evaluation and assessment of thyroid function are recommended in patients with ESRD on HD .