ECE2013 Poster Presentations Thyroid (non-cancer) (100 abstracts)
Haemodialysis-induced changes in thyroid hormones and thyrotropin
Jiri Horacek 1 , Sylvie Dusilova Sulkova 2 , Eva Malirova 3 , Blanka Dlabalova 3 , Roman Safranek 2 , Michaela Kubisova 4 , Marta Kalousova 5 , Jaroslav Maly 1 & Pavel Zak 1
1Department of Internal Medicine IV, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic; 2Faculty of Medicine and University Hospital in Hradec Kralove, Haemodialysis Centre, Charles University in Prague, Hradec Kralove, Czech Republic; 3Department of Nuclear Medicine, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic; 4Department of Internal Medicine III, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic; 5First Faculty of Medicine and General University Hospital in Prague, Institute of Clinical Chemistry and Laboratory Diagnostics, Charles University in Prague, Prague, Czech Republic.
Introduction: In end-stage renal disease (ESRD), thyroid function tests are often abnormal, and their interpretation is not always straightforward. While haemodialysis (HD) procedure has well-established profound effects on the serum levels of a variety of molecules no such data have been published on thyroid hormones.
Methods: In 110 ESRD patients, total and free thyroxine (T4 and fT4), total and free triiodothyronine (T3 and fT3), reverse triiodothyronine (rT3) and TSH levels were measured before and after a routine 4-h HD procedure using radioisotope assays.
Results: All thyroid hormones rose significantly (P<0.001, Wilcoxon) during HD: T4 by (median) 18.1% from (median) 70.9 to 91.1 nmol/l, fT4 by 45.5% from 12.07 to 17.87 pmol/l, T3 by 14.6% from 0.98 to 1.12 nmol/l, fT3 by 8.7% from 3.39 to 3.61 pmol/l, and rT3 by 15.7% from 0.265 to 0.311 nmol/l. Conversely, TSH levels after HD (median 1.60 mIU/l) were significantly lower (P<0.001, Wilcoxon) than before HD (1.80 mIU/l), probably reflecting the feedback inhibition.
Conclusion: The concordant rise in all thyroid hormones, with obvious maximum in fT4, together with a decrease in TSH, suggests an increased release of the hormones (preferentially of fT4) from the thyroid gland. This may be due to a removal of an inhibitor during HD procedure, perhaps of an excess of iodide (Wolff-Chaikoff effect), giving further support to the presumed link between iodine excess and increased prevalence of goitre and hypothyroidism in ESRD. Other putative inhibitors among non-specific uremic toxins may also be involved, as well as metabolic acidosis correction during HD. Finally, the information about timing of blood sample (before vs after HD) may be important for proper interpretation of thyroid function tests in HD patients.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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