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Abnormality of thyroid function tests in geriatric population undergoing chronic dialysis

Year 2014, Volume: 4 Issue: 2, 54 - 58, 01.08.2014

Abstract

Objective: There is not enough data about how thyroid hormones were affected in geriatric dialysis patients and whether age and duration of disease could be considered as additional risk factors for the thyroid function test abnormalities. For this reason we aimed to compare thyroid function tests of elderly chronic dialysis patients and elderly healthy controls.

Methods: Forty six chronic dialysis patients (24 peritoneal dialysis (PD) and 22 hemodialysis(HD)) and 44 healthy controls were taken into the study. After the physical examination, we collected patients’ and controls’ fasting blood samples and thereafter thyroid function tests were performed. In dialysis group thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (ft4) analysis of all patients were performed, but in control group free hormone levels were not studied at 14 of 44. 

Results: Serum TSH and fT4 levels were similar in two groups, however fT3 levels were found to be less in dialysis group ( 2.48 ± 0.57 and 3.06 ± 0.90 p= 0.003). Low fT3 syndrome was not detected in controls, but 7 (15,2%) patients have had  low fT3 syndrome in dialysis patients (p=0,01). The rate of thyroid function test abnormalities were higher at dialysis patients as compared with controls, 22 (47,8%) and 12 (40 %), respectively (p=0,05).

Conclusions: Elderly dialysis patients had higher thyroid function test abnormalities than controls. They had lower fT3 levels than controls such as young and middle age chronic dialysis patients. However, what does it mean for clinical process and how its clinical expression is not clearly known, especially in an elderly patients. Large, prospective, randomized and controlled trials are necessary for this topic.

Key words: dialysis, elderly, free T3

References

  • Lim VS: Thyroid function in patients with chronic renal failure. Am J Kidney Dis 2001; 38: S80-84.
  • De Groot LJ: Dangerous dogmas in medicine: the nonthyroidal illness syndrome. J Clin Endocrinol Metab 1999;84:151-164.
  • Meuwese CL, Dekker FW, Lindholm B, Qureshi AR, Heimburger O, Barany P, et al: Baseline levels and trimestral variation of triiodothyronine and thyroxine and their association with mortality in maintenance hemodialysis patients. Clin J Am Soc Nephrol 2012;7:131-138.
  • in YC, Chen TW, Yang WC, Lin CC: Abnormal thyroid function predicts mortality in patients receiving long-term peritoneal dialysis: a case-controlled longitudinal study. J Chin Med Assoc 2012;75:54-59.
  • Enia G, Panuccio V, Cutrupi S, Pizzini P, Tripepi G, Mallamaci F, et al: Subclinical hypothyroidism is linked to micro-inflammation and predicts death in continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 2007;22:538-544.
  • Zoccali C, Benedetto F, Mallamaci F, Tripepi G, Cutrupi S, Pizzini P, et al: Low triiodothyronine and cardiomyopathy in patients with end-stage renal disease. J Hypertens 2006;24:2039-2046.
  • Zoccali C, Tripepi G, Cutrupi S, Pizzini P, Mallamaci F: Low triiodothyronine: a new facet of inflammation in end-stage renal disease. J Am Soc Nephrol;2005:16:2789-2795.
  • Papalia T, Greco R, Lofaro D, Mollica A, Bonofiglio R: Thyroid status and kidney transplantation outcomes. Transplant Proc 2011;43:1042-1044.
  • Fernandez-Reyes MJ, Diez JJ, Collado A, Iglesias P, Bajo MA, Estrada P, et al: Are low concentrations of serum triiodothyronine a good marker for long-term mortality in hemodialysis patients? Clin Nephrol 2010;73:238-240.
  • Carrero JJ, Qureshi AR, Axelsson J, Yilmaz MI, Rehnmark S, Witt MR, 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;262:690-701.
  • Ozen KP, Asci G, Gungor O, Carrero JJ, Kircelli F, Tatar E, et al: Nutritional state alters the association between free triiodothyronine levels and mortality in hemodialysis patients. Am J Nephrol 2011;33:305-312.
  • Kaptein EM, Quion-Verde H, Chooljian CJ, Tang WW, Friedman PE, Rodriquez HJ, et al: The thyroid in end-stage renal disease. Medicine (Baltimore) 1988;67:187-97.
  • Targher G, Chonchol M, Zoppini G, Salvagno G, Pichiri I, Franchini M, et al: Prevalence of thyroid autoimmunity and subclinical hypothyroidism in persons with chronic kidney disease not requiring chronic dialysis. Clin Chem Lab Med 2009; 47:1367-1371.
  • Lin CC, Chen TW, Ng YY, Chou YH, Yang WC: Thyroid dysfunction and nodular goiter in hemodialysis and peritoneal dialysis patients. Perit Dial Int 1998;18:516-521.
  • Ng YY, Wu SC, Lin HD, Hu FH, Hou CC, Chou YY, et al: Prevalence of clinical and subclinical thyroid disease in a peritoneal dialysis population. Perit Dial Int 2012; 32: 86-93.
  • Kang EW, Nam JY, Yoo TH, Shin SK, Kang SW, Han DS, et al: Clinical implications of subclinical hypothyroidism in continuous ambulatory peritoneal dialysis patients. Am J Nephrol 2008:28:908-913.
  • Cappola AR, Fried LP, Arnold AM, Danese MD, Kuller LH, Burke GL, et al: Thyroid status, cardiovascular risk, and mortality in older adults. JAMA 2006;295:1033-1041.

Yaşlı Kronik Diyaliz Hastalarında Tiroid Fonksiyon Test Anormallikleri

Year 2014, Volume: 4 Issue: 2, 54 - 58, 01.08.2014

Abstract

Amaç: Geriatrik diyaliz hastalarında tiroid hormonlarının nasıl etkilendiğine dair yeterli
veri yoktur. Ayrıca bu hastalarda yaş ve hastalık süresinin tiroid fonksiyon testi anormallikleri
açısından ek bir risk faktörü olup olmadığı bilinmemektedir. Bu yüzden bu çalışmada yaşlı
kronik diyaliz hastalarının ve yaşlı sağlıklıların tiroid fonksiyon testlerini karşılaştırmayı
amaçladık.
Gereç ve Yöntemler: Kırk altı kronik diyaliz hastası (24 periton diyalizi (PD) ve 22
hemodiyaliz (HD)) ve 44 sağlıklı kontrol çalışmaya dahil edildi. Yapılan fizik muayene
sonrasında hasta ve kontrol grubundan alınan açlık kan örneklerinden tiroid fonksiyon testleri
çalışıldı. Diyaliz grubunda tüm hastalara tiroid stimüle edici hormon (TSH), serbest
triiyodotironin (sT3) ve serbest tiroksin (sT4) çalışıldı, ancak kontrol grubunda 44 hastanın
14’ünde serbest hormon ölçümleri yapılamadı.
Bulgular: Serum TSH ve sT4 düzeyleri iki grupta benzerdi, ancak sT3 düzeyleri diyaliz
grubunda daha düşük bulundu (2.48 ± 0.57 ve 3.06 ± 0.90 p= 0.003). Kontrol grubunda düşük
sT3 sendromu görülmezken, diyaliz hastalarının 7( % 15,2)’ sinde düşük sT3 sendromu
saptandı (p=0,01). Tiroid fonksiyon test bozukluğu oranı diyaliz hastalarında daha fazla
bulundu, sırayla 22 (% 47,8)’ye karşın 12 (%40) (p=0,05).
Sonuçlar: Yaşlı diyaliz hastaları, sağlıklı kontrollere göre daha çok tiroid fonksiyon test
anormalliklerine sahipti. Ayrıca bu hastalar, tıpkı genç ve orta yaşlı kronik diyaliz hastaları gibi,
kontrol grubuna göre daha düşük sT3 düzeylerine sahipti. Bununla birlikte, bu sonuçların klinik
süreçte ne anlama geldiği ve kliniğe nasıl bir yansımasının olduğu, özellikle yaşlı hastalarda
henüz açık değildir. Bu konuda büyük, ileriye dönük, randomize ve kontrollü çalışmalara
ihtiyaç vardır.

References

  • Lim VS: Thyroid function in patients with chronic renal failure. Am J Kidney Dis 2001; 38: S80-84.
  • De Groot LJ: Dangerous dogmas in medicine: the nonthyroidal illness syndrome. J Clin Endocrinol Metab 1999;84:151-164.
  • Meuwese CL, Dekker FW, Lindholm B, Qureshi AR, Heimburger O, Barany P, et al: Baseline levels and trimestral variation of triiodothyronine and thyroxine and their association with mortality in maintenance hemodialysis patients. Clin J Am Soc Nephrol 2012;7:131-138.
  • in YC, Chen TW, Yang WC, Lin CC: Abnormal thyroid function predicts mortality in patients receiving long-term peritoneal dialysis: a case-controlled longitudinal study. J Chin Med Assoc 2012;75:54-59.
  • Enia G, Panuccio V, Cutrupi S, Pizzini P, Tripepi G, Mallamaci F, et al: Subclinical hypothyroidism is linked to micro-inflammation and predicts death in continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 2007;22:538-544.
  • Zoccali C, Benedetto F, Mallamaci F, Tripepi G, Cutrupi S, Pizzini P, et al: Low triiodothyronine and cardiomyopathy in patients with end-stage renal disease. J Hypertens 2006;24:2039-2046.
  • Zoccali C, Tripepi G, Cutrupi S, Pizzini P, Mallamaci F: Low triiodothyronine: a new facet of inflammation in end-stage renal disease. J Am Soc Nephrol;2005:16:2789-2795.
  • Papalia T, Greco R, Lofaro D, Mollica A, Bonofiglio R: Thyroid status and kidney transplantation outcomes. Transplant Proc 2011;43:1042-1044.
  • Fernandez-Reyes MJ, Diez JJ, Collado A, Iglesias P, Bajo MA, Estrada P, et al: Are low concentrations of serum triiodothyronine a good marker for long-term mortality in hemodialysis patients? Clin Nephrol 2010;73:238-240.
  • Carrero JJ, Qureshi AR, Axelsson J, Yilmaz MI, Rehnmark S, Witt MR, 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;262:690-701.
  • Ozen KP, Asci G, Gungor O, Carrero JJ, Kircelli F, Tatar E, et al: Nutritional state alters the association between free triiodothyronine levels and mortality in hemodialysis patients. Am J Nephrol 2011;33:305-312.
  • Kaptein EM, Quion-Verde H, Chooljian CJ, Tang WW, Friedman PE, Rodriquez HJ, et al: The thyroid in end-stage renal disease. Medicine (Baltimore) 1988;67:187-97.
  • Targher G, Chonchol M, Zoppini G, Salvagno G, Pichiri I, Franchini M, et al: Prevalence of thyroid autoimmunity and subclinical hypothyroidism in persons with chronic kidney disease not requiring chronic dialysis. Clin Chem Lab Med 2009; 47:1367-1371.
  • Lin CC, Chen TW, Ng YY, Chou YH, Yang WC: Thyroid dysfunction and nodular goiter in hemodialysis and peritoneal dialysis patients. Perit Dial Int 1998;18:516-521.
  • Ng YY, Wu SC, Lin HD, Hu FH, Hou CC, Chou YY, et al: Prevalence of clinical and subclinical thyroid disease in a peritoneal dialysis population. Perit Dial Int 2012; 32: 86-93.
  • Kang EW, Nam JY, Yoo TH, Shin SK, Kang SW, Han DS, et al: Clinical implications of subclinical hypothyroidism in continuous ambulatory peritoneal dialysis patients. Am J Nephrol 2008:28:908-913.
  • Cappola AR, Fried LP, Arnold AM, Danese MD, Kuller LH, Burke GL, et al: Thyroid status, cardiovascular risk, and mortality in older adults. JAMA 2006;295:1033-1041.
There are 17 citations in total.

Details

Primary Language English
Journal Section Original Research
Authors

Mustafa Altay

Selman Ünverdi This is me

Mevlüt Çeri This is me

Salih Başer This is me

Mesudiye Bulut This is me

Murat Duranay This is me

Publication Date August 1, 2014
Published in Issue Year 2014 Volume: 4 Issue: 2

Cite

APA Altay, M., Ünverdi, S., Çeri, M., Başer, S., et al. (2014). Abnormality of thyroid function tests in geriatric population undergoing chronic dialysis. Çağdaş Tıp Dergisi, 4(2), 54-58.
AMA Altay M, Ünverdi S, Çeri M, Başer S, Bulut M, Duranay M. Abnormality of thyroid function tests in geriatric population undergoing chronic dialysis. J Contemp Med. August 2014;4(2):54-58.
Chicago Altay, Mustafa, Selman Ünverdi, Mevlüt Çeri, Salih Başer, Mesudiye Bulut, and Murat Duranay. “Abnormality of Thyroid Function Tests in Geriatric Population Undergoing Chronic Dialysis”. Çağdaş Tıp Dergisi 4, no. 2 (August 2014): 54-58.
EndNote Altay M, Ünverdi S, Çeri M, Başer S, Bulut M, Duranay M (August 1, 2014) Abnormality of thyroid function tests in geriatric population undergoing chronic dialysis. Çağdaş Tıp Dergisi 4 2 54–58.
IEEE M. Altay, S. Ünverdi, M. Çeri, S. Başer, M. Bulut, and M. Duranay, “Abnormality of thyroid function tests in geriatric population undergoing chronic dialysis”, J Contemp Med, vol. 4, no. 2, pp. 54–58, 2014.
ISNAD Altay, Mustafa et al. “Abnormality of Thyroid Function Tests in Geriatric Population Undergoing Chronic Dialysis”. Çağdaş Tıp Dergisi 4/2 (August 2014), 54-58.
JAMA Altay M, Ünverdi S, Çeri M, Başer S, Bulut M, Duranay M. Abnormality of thyroid function tests in geriatric population undergoing chronic dialysis. J Contemp Med. 2014;4:54–58.
MLA Altay, Mustafa et al. “Abnormality of Thyroid Function Tests in Geriatric Population Undergoing Chronic Dialysis”. Çağdaş Tıp Dergisi, vol. 4, no. 2, 2014, pp. 54-58.
Vancouver Altay M, Ünverdi S, Çeri M, Başer S, Bulut M, Duranay M. Abnormality of thyroid function tests in geriatric population undergoing chronic dialysis. J Contemp Med. 2014;4(2):54-8.