title: Importance of specific reference values for evaluation of the deteriorating thyroid function in patients with end-stage renal disease on hemodialysis.
abstract: OBJECTIVE
  We evaluated the thyroid function in end-stage renal disease (ESRD) on maintenance hemodialysis.
  
  
  METHODS
  Thyroid function and clinical hypothyroid score were evaluated in 145 ESRD patients.
  
  
  RESULTS
  Comparison of thyroid function between 127 ESRD patients, excluding 18 patients with suppressed or elevated serum TSH level, and age/sex-matched healthy controls (76 in midlife group aged under 65 and 51 in late-life group aged 65 or over) using a multivariate logistic regression analysis suggested significant difference (P < 0.0001), mainly in serum fT4 level (P = 0.0099) and age (P = 0.0492), but not in serum fT3 (not significant; ns), TSH (ns) level or fT3/fT4 ratio (ns). Serum fT3 level and fT3/fT4 ratio were significantly lower (P < 0.001) in late-life group only in ESRD. Reference values calculated for midlife ESRD patients, such as 0.6-1.3 ng/dl for fT4 compared with 0.8-1.7 ng/dl for healthy control, were helpful for the diagnosis of mild but definite hyperthyroidism in whom serum fT4 level was 1.5 ng/dl. The prevalence of primary thyroid dysfunction, compared with the values for ESRD, was 0.7 % for hyperthyroidism, 1.4 % for overt hypothyroidism and 10.3 % for subclinical hypothyroidism. Hypothyroid score was high among those with ESRD independent of thyroid dysfunction.
  
  
  CONCLUSIONS
  Serum fT4 level was markedly lower without a change in fT3/fT4 ratio in ESRD. This may suggest typical carbohydrate-sufficient non-thyroidal illness. The specific reference values for ESRD were useful to evaluate borderline thyroid dysfunction and to evaluate the prevalence of the patients with primary thyroid dysfunction in ESRD.
authors.affiliation: The Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga-city, Saga, 849-8501, Japan. sunny@fukumitsu-hospital.jp.|The Department of Nephrology, Abe Clinic, 2-3-8 Taharashin-machi, Kokuraminami-ku, Kitakyushu-city, Fukuoka, 800-0226, Japan. sunny@fukumitsu-hospital.jp.|The Division of Nephrology, Department of Internal Medicine, Fukumitsu Hospital, 4-10-1 Kashiihama, Higashi-ku, Fukuoka-city, Fukuoka, 813-0016, Japan. sunny@fukumitsu-hospital.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Sanai
authors.affiliation: The Department of Medicine and Clinical Science (The Second Department of Internal Medicine), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-city, Fukuoka, 812-8582, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Okamura
authors.affiliation: The Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga-city, Saga, 849-8501, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Kishi
authors.affiliation: The Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga-city, Saga, 849-8501, Japan.
authors.forename: Motoaki
authors.initials: M
authors.lastname: Miyazono
authors.affiliation: The Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga-city, Saga, 849-8501, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ikeda
authors.affiliation: The Department of Medicine and Clinical Science (The Second Department of Internal Medicine), Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-city, Fukuoka, 812-8582, Japan.
authors.forename: Takanari
authors.initials: T
authors.lastname: Kitazono
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D006435:Renal Dialysis / Q000009:adverse effects; D013960:Thyroid Function Tests / Q000592:standards*; D013961:Thyroid Gland / Q000378:metabolism*; D013972:Thyrotropin / Q000097:blood; D055815:Young Adult
chemical_list: D013972:Thyrotropin
keywords: End-stage renal disease (ESRD); Hyperthyroidism; Hypothyroidism; Non-thyroidal illness (low triiodothyronine syndrome) (NTI); Thyroid-stimulating hormone (TSH)