title: High prevalence of subclinical hypothyroidism and nodular thyroid disease in patients on hemodialysis.
abstract: Chronic kidney disease has been known to affect thyroid hormone metabolism. Low serum levels of T3 and T4 are the most remarkable laboratorial findings. A high incidence of goiter and nodules on thyroid ultrasonography has been reported in patients with end-stage renal disease (ESRD). Our objective is to evaluate the prevalence of laboratorial and morphologic alterations in the thyroid gland in a cohort of patients with ESRD on hemodialysis (HD). Sixty-one patients with ESRD on HD were selected and compared with 43 healthy subjects matched by age, gender, and weight. Patients were submitted to thyroid ultrasonography. T3, free T4 (FT4), thyroid-stimulating hormone, antithyroglobulin, and antithyroperoxidase antibodies were measured. The mean age of patients with ESRD was 47.4 ± 12.3 and 61% were women. ESRD was mainly caused by hypertensive nephrosclerosis and diabetic nephropathy. Mean thyroid volume, as determined by ultrasonography, was similar in both groups. Patients with ESRD had more hypoechoic nodules when compared with the control group (24.1% vs. 7.9%, P = 0.056). Mean serum FT4 and T3 levels were significantly lower in patients with ESRD, and subclinical hypothyroidism was more prevalent in patients with ESRD (21.82% vs. 7.14% control group, P = 0.04). Titers of antithyroid antibodies were similar in both groups. ESRD was associated with a higher prevalence of subclinical hypothyroidism and lower levels of T3 and FT4. Almost a quarter of patients showed thyroid nodules >10 mm. Periodic ultrasound evaluation and assessment of thyroid function are recommended in patients with ESRD on HD.
authors.affiliation: Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.
authors.forename: Ana Beatriz B A
authors.initials: AB
authors.lastname: Da Costa
authors.affiliation: Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.
authors.forename: Caio
authors.initials: C
authors.lastname: Pellizzari
authors.affiliation: Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, Brazil.
authors.forename: Gisah A
authors.initials: GA
authors.lastname: Carvalho
authors.affiliation: Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.
authors.forename: Beatriz C
authors.initials: BC
authors.lastname: Sant'Anna
authors.affiliation: Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.
authors.forename: Rafaela L
authors.initials: RL
authors.lastname: Montenegro
authors.affiliation: Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.
authors.forename: Roberto G
authors.initials: RG
authors.lastname: Zammar Filho
authors.affiliation: Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, Brazil.
authors.forename: Cleo O
authors.initials: CO
authors.lastname: Mesa Junior
authors.affiliation: Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, Brazil.
authors.forename: Patrícia R
authors.initials: PR
authors.lastname: Hauck Prante
authors.affiliation: Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.
authors.forename: Marcia
authors.initials: M
authors.lastname: Olandoski
authors.affiliation: Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil.|Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, Brazil.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D016606:Thyroid Nodule / Q000209:etiology*; D055815:Young Adult
keywords: Hypothyroidism; end-stage renal disease; hemodialysis; thyroid nodule