Altered thyroid in dialysed uremic patients

Thyroid abnormalities were studied in 40 uremic patients half of whom were receiving hemodialysis and half peritoneal dialysis. The following parameters were examined in all patients: total and free thyroxinemia, free and total triiodothyroninemia, basal thyreotropinemia and levels 20 mins after releasing hormone (TRH) stimulation, reverse T3, thyroglobulinemia, antithyroglobulin , antimicrosomial and antithyroperoxidase antibodies; a thyroid echography was also performed. Numerous alterations were found in thyroid parameters, with a greater frequency in hemodialysed patients (65%) than those undergoing peritoneal dialysis (52.5%). Among the parameters examined it is worth noting that total thyroxinemia was significantly reduced compared to controls, and FT3 was very significantly reduced. Among those patients undergoing peritoneal dialysis thyreotropinemia was increased in 6 cases (15%), whereas among hemodialysed patients it was reduced in 2 cases (5%). Ten patients (25%) in all appeared to be free of thyroid alterations and 30 (75%) showed one or more alteration of the parameters examined. Of the latter, 1 case of toxic multinodular goiter, 1 case of Plummer's adenoma in a pretoxic phase, 1 case of hypothyroidism, 15 cases of "sick euthyroid of syndrome", 3 cases with high antibody levels and 2 cases of single node goitre were diagnosed. The study confirmed the high incidence of thyroid alterations in uremic patients and, surprisingly, allowed the authors to diagnose a case of toxic multinodular goitre and a case of Plummer's adenoma at a pretoxic phase. The authors discuss the rarity of thyroid hyperfunction in uremia and suggest the need to consider patients with chronic renal insufficiency as being at risk of hypo-, normo- and hyperfunctioning thyreopathy, and to use a routine thyreotropinemia assay in all uremic patients