[Nephrotic syndrome: don't forget to search for hypothyroidism].
BACKGROUND
If abnormal thyroid function indices have been reported in patients with nephrotic syndrome, hypothyroidism is exceptional.


METHODS
We report three adult patients (1, 2, 3) with hypothyroidism associated with nephrotic syndrome (minimal change glomerulonephritis [1], idiopathic membranous nephropathy stage I [2], stage II [3]). Glomerulopathy treatment and thyroid hormone replacement therapy were both initiated. Low replacement (1, 2) was sufficient when proteinuria decreased. It was higher when nephrotic syndrome was uncontrolled (3).


CONCLUSIONS
Excessive thyroxine-binding protein and thyroxine urinary loss generate low rate of free thyroxine and elevated TSH. Systematic thyroid hormonal test is necessary if nephrotic syndrome is severe and prolonged.
Trouillier
S
S
Service de médecine interne, CHU Gabriel-Montpied, 58, rue Montalembert, B.P. 69, 63001 Clermont-Ferrand cedex, France. trouillier.s@club-internet.fr <trouillier.s@club-internet.fr>
Delèvaux
I
I
Rancé
N
N
André
M
M
Voinchet
H
H
Aumaître
O
O
D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D015433:Glomerulonephritis, Membranous / Q000150:complications / Q000175:diagnosis; D005938:Glucocorticoids / Q000627:therapeutic use; D020249:Hormone Replacement Therapy; D006801:Humans; D007037:Hypothyroidism / Q000150:complications* / Q000175:diagnosis; D008297:Male; D009402:Nephrosis, Lipoid / Q000150:complications / Q000175:diagnosis; D009404:Nephrotic Syndrome / Q000150:complications* / Q000175:diagnosis; D013974:Thyroxine / Q000627:therapeutic use
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D005938:Glucocorticoids; D013974:Thyroxine