Hypothyroidism and Nephrotic Syndrome: Why, When and How to Treat.
BACKGROUND
Hypothyroidism, characterised by low/normal free thyroxine (FT4) and free triiodothyronine (FT3) with elevated thyroid-stimulating hormone (TSH), is a well-known complication of nephrotic syndrome (NS). This is a common feature of primary and secondary glomerular diseases and comprises loss of protein in the urine and increased urinary excretion of thyroid hormones and thyroxine- binding globulin. With a normal thyroid reserve, this scenario is associated with the development of subclinical hypothyroidism, with a slight increase in TSH and normal free fractions. However, with a low thyroid reserve the transition toward overt hypothyroidism is almost inevitable, affecting morbidity and mortality. As T4 replacement is a cheap and well-established treatment to achieve a stable hormone status in different types of thyroid deficiency, it is essential to recognise and appropriately treat this condition.


CONCLUSIONS
In this article we summarise the evidence on this nephro-endocrine disorder in humans and focus on diagnostic and therapeutic strategies.
Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome. Italy.
F Di
FD
Mario
Department of Experimental Medicine, Sapienza University of Rome, Rome. Italy.
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R
Pofi
Department of Clinical Medicine, Sapienza, University of Rome, Viale dell'Università, 37, 00185 Rome. Italy.
A
A
Gigante
Nephrology and Dialysis Unit, Magna Graecia University, Catanzaro. Italy.
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L
Rivoli
Department of Clinical Medicine, Sapienza University of Rome, Rome. Italy.
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E
Rosato
Department of Experimental Medicine, Sapienza University of Rome, Rome. Italy.
A M
AM
Isidori
Department of Clinical Medicine, Sapienza University of Rome, Rome. Italy.
R
R
Cianci
Department of Clinical Medicine, Sapienza University of Rome, Rome. Italy.
B
B
Barbano
D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D009404:Nephrotic Syndrome / Q000150:complications*; D013963:Thyroid Hormones / Q000378:metabolism; D013972:Thyrotropin / Q000378:metabolism; D013974:Thyroxine / Q000378:metabolism / Q000627:therapeutic use*
D013963:Thyroid Hormones; D013972:Thyrotropin; D013974:Thyroxine
Nephrotic syndrome; glomerulonephritis; hypothyroidism; replacement; thyroid hormones; treatment