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Horm Metab Res 2007; 39(5): 355-358
DOI: 10.1055/s-2007-976536
Original Clinical

© Georg Thieme Verlag KG Stuttgart · New York

Differential T4 Degradation Pathways in Young Patients with Preterminal and Terminal Renal Failure

O. Witzke 1 , J. Wiemann 2 , D. Patschan 1 , K. Wu 1 , T. Philipp 1 , B. Saller 2 , K. Mann 2 , W. Reinhardt 1 , 2
  • 1Department of Medicine, Division of Nephrology and Hypertension, University Hospital Essen, Hufelandstraße 55, Essen, Germany
  • 2Department of Medicine, Division of Endocrinology, University Hospital Essen, Hufelandstraße 55, Essen, Germany
Further Information

Publication History

received 14. 8. 2006

accepted 1. 12. 2006

Publication Date:
29 May 2007 (online)

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Abstract

Introduction: The aim of this study is to analyze thyroid hormone parameters in large homogenous patient cohorts with preterminal (stage 4) and terminal (stage 5) renal failure in an area of low iodine intake.

Patients and Methods: Thyroid parameters were measured in healthy controls (n=48), patients with preterminal renal failure (n=48) and patients with terminal renal failure undergoing hemodialysis (n=288). All patients were assessed by measurement of TSH, T4, T3, fT4, rT3, Tg and TPO-antibodies.

Results: There was a significant decrease of T4 and fT4 from healthy controls to patients with preterminal renal failure and to patients with terminal renal failure. T3 showed a decrease from healthy controls to patients with preterminal renal failure and to patients with terminal renal failure (1.54±0.06 μg/l vs. 1.05±0.05 μg/l vs. 1.09±0.23 μg/l, p<0.001 vs. controls). rT3 was significantly decreased in patients with terminal renal failure (0.24±0.01 μg/l vs. 0.25±0.02 μg/l vs. 0.16±0.01 μg/l, p<0.001). The rT3/T3 ratio was significantly elevated in patients with preterminal renal failure (p<0.01). TSH concentrations were in the normal range in all groups.

Conclusion: Our data suggest different T4 degradation pathways in patients with preterminal and terminal renal failure.

Key words

dialysis - non-thyroidal illness - renal failure - rT3 - TSH (Thyroid-Stimulating Hormone)

References

  • 1 Docter R, Krenning EP, de Jong M, Hennemann G. The sick euthyroid syndrome: changes in thyroid hormone serum parameters and hormone metabolism.  Clin Endocrinol (Oxf). 1993;  39 499-518
    PubMedGoogle Scholar
  • 2 Lo JC, Chertow GM, Go AS, Hsu CY. Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease.  Kidney Int. 2005;  67 1047-1052
    CrossrefPubMedGoogle Scholar
  • 3 De Marchi S, Cecchin E, Villalta D, Tesio F. Serum reverse T3 assay for predicting glucose intolerance in uremic patients on dialysis therapy.  Clin Nephrol. 1987;  27 189-198
    PubMedGoogle Scholar
  • 4 Lim VS. Thyroid function in patients with chronic renal failure.  Am J Kidney Dis. 2001;  38 ((Suppl 1)) S80-S84
    PubMedGoogle Scholar
  • 5 Verger MF, Verger C, Hatt-Magnien D, Perrone F. Relationship between thyroid hormones and nutrition in chronic renal failure.  Nephron. 1987;  45 211-215
    PubMedGoogle Scholar
  • 6 Zoccali C, Mallamaci F, Tripepi G, Cutrupi S, Pizzini P. Low triiodothyronine and survival in end-stage renal disease.  Kidney Int. 2006;  70 523-528
    PubMedGoogle Scholar
  • 7 Kaptein EM, Quion-Verde H, Chooljian CJ, Tang WW, Friedman PE, Rodriquez HJ, Massry SG. The thyroid in end-stage renal disease.  Medicine. 1988;  67 187-197
    PubMedGoogle Scholar
  • 8 Goffin E, Oliveria DB, Raggatt P, Evans DB. Assessment of the thyroid function of patients undergoing regular haemodialysis.  Nephron. 1993;  65 568-572
    PubMedGoogle Scholar
  • 9 Nishikawa M, Ogawa Y, Yoshikawa N, Yoshimura M, Toyoda N, Shouzu A, Inada M. Plasma free thyroxine (FT4) concentrations during hemodialysis in patients with chronic renal failure: effects of plasma non-esterified fatty acids on FT4 measurement.  Endocr J. 1996;  43 487-493
    PubMedGoogle Scholar
  • 10 National Kidney Foundation . Dialysis Outcomes Quality Initiative.  Am J Kidney Dis. 2002;  39 ((Suppl)) S1-S266
    CrossrefPubMedGoogle Scholar
  • 11 Amado JA, Suarez M, de Francisco AM. Thyroglobulin and thyroid function in patients on regular hemodialysis.  Nephron. 1986;  43 160
    PubMedGoogle Scholar
  • 12 Iitaka M, Kawasaki S, Sakurai S, Hara Y, Kuriyama R, Yamanaka K, Kitahama S, Miura S, Kawakami Y, Katayama S. Serum substances that interfere with thyroid hormone assays in patients with chronic renal failure.  Clin Endocrinol. 1998;  48 739-746
    CrossrefPubMedGoogle Scholar
  • 13 Yonemura K, Nakajima T, Suzuki T, Ando S, Genma R, Nakamura H, Hishida A. Low free thyroxine concentrations and deficient nocturnal surge of thyroid-stimulating hormone in haemodialysed patients compared with undialysed patients.  Nephrol Dial Transplant. 2000;  15 668-672
    PubMedGoogle Scholar
  • 14 Faber J, Heaf J, Kirkegaard C, Lumholtz IB, Siersbaek-Nielsen K, Kolendorf K, Friis T. Simultaneous turnover studies of thyroxine, 3,5,3′ and 3,3′,5′-triiodothyronine, 3,5-, 3,3′-, and 3′,5′-diiodothyronine, and 3′-monoiodothyronine in chronic renal failure.  J Clin Endocrinol Metab. 1983;  56 211-217
    PubMedGoogle Scholar
  • 15 Lim VS, Fang VS, Katz AI, Refetoff S. Thyroid dysfunction in chronic renal failure. A study of the pituitary-thyroid axis and peripheral turnover kinetics of thyroxine and triiodothyronine.  J Clin Invest. 1977;  60 522-534
    PubMedGoogle Scholar
  • 16 Kaptein EM, Kaptein JS, Chang EI, Egodage PM, Nicoloff JT, Massry SG. Thyroxine transfer and distribution in critical nonthyroidal illnesses, chronic renal failure, and chronic ethanol abuse.  J Clin Endocrinol Metab. 1987;  65 606-616
    PubMedGoogle Scholar
  • 17 Spector DA, Davis PJ, Helderman JH, Bell B, Utiger RD. Thyroid function and metabolic state in chronic renal failure.  Ann Intern Med. 1976;  85 724-730
    PubMedGoogle Scholar
  • 18 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
    CrossrefPubMedGoogle Scholar
  • 19 Kosowicz J, Malczewska B, Czekalski S. Serum reverse triiodothyronine (3,3′,5′-l-triiodothyronine) in chronic renal failure.  Nephron. 1980;  26 85-89
    PubMedGoogle Scholar
  • 20 Thysen B, Gatz M, Freeman R, Alpert BE, Charytan C. Serum thyroid hormone levels in patients on continuous ambulatory peritoneal dialysis and regular hemodialysis.  Nephron. 1983;  33 49-52
    PubMedGoogle Scholar
  • 21 Kaptein EM, Feinstein EI, Nicoloff JT, Massry SG. Serum reverse triiodothyronine and thyroxine kinetics in patients with chronic renal failure.  J Clin Endocrinol Metab. 1983;  57 181-189
    PubMedGoogle Scholar
  • 22 van Leusen R, Meinders AE. Cyclical changes in serum thyroid hormone concentrations related to hemodialysis: movement of hormone into and out of the extravascular space as a possible mechanism.  Clin Nephrol. 1982;  18 193-199
    PubMedGoogle Scholar
  • 23 Köhrle J, Jakob F, Contempré B, Dumont JE. Selenium, the thyroid, and the endocrine system.  Endocrine Reviews. 2005;  26 944-984
    CrossrefPubMedGoogle Scholar
  • 24 Yilmaz MI, Saglam M, Caglar K, Cakir E, Sonmez A, Ozgurtas T, Aydin A, Eyileten T, Ozcan O, Acikel C, Tasar M, Genctoy G, Erbil K, Vural A, Zoccali C. The determinants of endothelial dysfunction in CKD: oxidative stress and asymmetric dimethylarginine.  Am J Kidney Dis. 2006;  47 42-50
    CrossrefPubMedGoogle Scholar
  • 25 Peters H, Stephan-Sump F, Rauhut E, Brätter E, Distler A. Selenium substitution improves thyroid de-iodination in patients on chronic hemodialysis.  Kidney Blood Press Res. 1998;  21 A
    PubMedGoogle Scholar
  • 26 Volzke H, Alte D, Kohlmann T, Ludemann J, Nauck M, John U, Meng W. Reference intervals of serum thyroid function tests in a previously iodine-deficient area.  Thyroid. 2005;  15 279-285
    CrossrefPubMedGoogle Scholar
  • 27 Custro N, Scafidi V, Gallo S, Notarbartolo A. Deficient pulsatile thyrotropin secretion in the low-thyroid-hormone state of severe non-thyroidal illness.  Eur J Endocrinol. 1994;  130 132-136
    PubMedGoogle Scholar

Correspondence

PD Dr. med W. Reinhardt

Endocrine Clinic and Dialysis Centre Herne

Wiescherstraße 20

44623 Herne

Germany

Phone: +49/2323/98 78 60

Fax: +49/2323/98 78 68 6

Email: w.reinhardt@dialyse-herne.de

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