Endocrine Abstracts

Neutrophil gelatinase-associated lipocalin (NGAL) was shown to be highly useful in assessing kidney injury in patients with diabetic nephropathy. Taking into account recent data that dysthyroidism may have reversible effects on GFR the purpose of the study was to investigate potential relationship between serum NGAL levels, thyroid status and ultrasound thyroid characteristics in patients with type 1 diabetes (T1D) with CKD.

Materials and methods: We recruited 118 patients (43m; 75f; age 40.78±12.241 years; BMI 25.50±4.956 kg/m²; duration of T1D 22.86±9.737 years) with CKD. Hypertension was observed in 76 (64.41%) patients, 56 (47.46%) took ACE inhibitors. Lipid profile changes were found in 87 (73.73%) patients, and only 30 (25.42%) of them received statins. GFR was estimated by CKD-EPI formula. All patients were divided into two groups: group 1 comprised 95 patients with GFR>45 ml/min, group 2 – 23 patients with GFR<45 ml/min. Biochemical parameters, NGAL, thyroid hormones levels were measured. USG of thyroid gland was performed. Nonparametric statistical methods were used. A P-value <0.05 was considered significant.

Results: Groups were matched by age, gender, HbA1c, TSH, fT4, ATPO levels, thyroid gland volume (VolThG). Comparative analysis of patients in the subgroups according to GFR revealed reliable differences in fT3 (P=0.028) and NGAL levels (P=0.0003). Low-fT3 was occurred significantly more often in group 2 – 34.78% vs 16.84% (χ²=4.5, P=0.034). Mean NGAL levels in patients with GFR<45 ml/min (1.98 [0.91; 3.29]) were higher than those in group with GFR>45 ml/min (0.88 [0.48; 1.30]). Presence of nodal pathology observed more frequently in group 2 – 39.13% vs 16.84% (χ²=5.5, P=0.019), despite the fact that there were no differences in presence of hypoechoic nodes >1 cm. Correlation of VolThG and NGAL (r=−0.288) and serum creatinine levels was revealed (r=0.222).

Conclusion: Decline of GFR leads to deviation from the normal structure of thyroid gland and developing of local nodal pathology in group of patients with T1D and is accompanied by an increase of NGAL levels and low-fT3.