Evaluate all newly diagnosed mild-moderate renal dysfunction patients for primary hypothyroidism

Karethimmaiah Hareesha Babu; Vijaya Sarathi; Rakesh Boppana

doi:10.18203/2320-6012.ijrms20162837

Authors

Karethimmaiah Hareesha Babu Department of Nephrology, Vydehi Institute of Medical Sciences and Research Center, Whitefield, Banaglore
Vijaya Sarathi Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Whitefield, Banaglore
Rakesh Boppana Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Center, Whitefield, Banaglore

DOI:

https://doi.org/10.18203/2320-6012.ijrms20162837

Keywords:

Hypothyroidism, Elevated creatinine, Hyponatremia, Renal dysfunction

Abstract

Background: Hypothyroidism often presents to nephrologists with elevated serum creatinine which may lead to unnecessary evaluation including renal biopsy.

Methods: We retrospectively analysed the data of 24 patients who presented to the department of nephrology at our institute with anasarca/facial puffiness or elevated serum creatinine and diagnosed to have hypothyroidism with TSH >40 µIU/ml.

Results: Twelve patients presented with generalised edema, eight patients for evaluation of deranged serum creatinine and four patients with both generalised edema and deranged serum creatinine. Age (r=0.696, p<0.001) and serum thyroid stimulating hormone (r=0.504, p=0.012) had significant positive correlation with serum creatinine whereas serum total thyroxine (r=-0.637, p<0.001) and triiodothyronine (r=-0.728, p<0.001) had significant negative correlation. Serum sodium was lower (<136 mmol/L) in eight patients. Age (r=-0.598, p<0.001), serum creatinine (r=-0.624, p<0.001), and serum thyroid stimulating hormone (r=-0.728, p=0.012) had significant negative correlation with serum sodium whereas serum total thyroxine (r=0.869, p<0.001) and triiodothyronine (r=.845, p<0.001) had significant positive correlation. Serum creatinine and sodium normalised in all after levothyroxine replacement.

Conclusions: To conclude, hypothyroidism is not an uncommon cause of mild-moderate renal dysfunction and often presents to nephrologists prompting unnecessary investigations including renal biopsy. Hence, all newly diagnosed mild-moderate renal failure patients should be tested to rule out primary hypothyroidism.

Metrics

Metrics Loading ...

References

Unnikrishnan AG, Kalra S, Sahay RK, Bantwal G, John M, Tewari N. Prevalence of hypothyroidism in adults: an epidemiological study in eight cities of India. Indian J Endocrinol Metab. 2013;17(4):647-52.

Hanmayyagari BR, Guntaka M, Nagesh S. Hypothyroidism a reversible cause of renal dysfunction. Med J DY Patil Univ. 2015;8:52-3.

Montenegro J, González O, Saracho R, Aguirre R, González O, Martínez I. Changes in renal function in primary hypothyroidism. Am J Kidney Dis. 1996;27(2):195-8.

Schmid C, Brändle M, Zwimpfer C, Zapf J, Wiesli P. Effect of thyroxine replacement on creatinine, insulin-like growth factor 1, acid-labile subunit, and vascular endothelial growth factor. Clin Chem. 2004;50(1):228-31.

Papadakis G, Kalaitzidou S, Triantafillou E, Drosou A, Kakava K, Dogkas N, et al. Biochemical effects of levothyroxine withdrawal in patients with differentiated thyroid cancer. Anticancer Res. 2015;35(12):6933-40.

Pantalone KM, Hatipoglu BA. Hyponatremia and the thyroid: causality or association? J Clin Med. 2015;4:32-6.

Sun GE, Pantalone KM, Hatipoglu B. Hypothyroidism as a cause of hyponatremia: fact or fiction? Endocr Pract. 2012;18(6):894-7.

Hunze J, IJsselstijn L, Wulkan RW, van Alphen AM. Does hypothyroidism cause hyponatremia? health. 2014;6:1453-8.

Shakir MK, Krook LS, Schraml FV, Hays JH, Clyde PW. Symptomatic hyponatremia in association with a low-iodine diet and levothyroxine withdrawal prior to I131 in patients with metastatic thyroid carcinoma. Thyroid. 2008;18(7):787-92.

Kim SK, Yun GY, Kim KH, Park SK, Choi HY, Ha SK, et al. Severe hyponatremia following radioactive iodine therapy in patients with differentiated thyroid cancer. Thyroid. 2014;24(4):773-7.

Hammami MM, Almogbel F, Hammami S, Faifi J, Alqahtani A, Hashem W. Acute severe hypothyroidism is not associated with hyponatremia even with increased water intake: a prospective study in thyroid cancer patients. BMC Endocr Disord. 2013;13:27.

Kreisman SH, Hennessey JV. Consistent reversible elevations of serum creatinine levels in severe hypothyroidism. Arch Intern Med. 1999;159(1):79-82.

Baajafer FS, Hammami MM, Mohamed GE. Prevalence and severity of hyponatremia and hypercreatininemia in short-term uncomplicated hypothyroidism. J Endocrinol Invest. 1999;22(1):35-9.

Luciani R, Falcone C, Principe F, Punzo G, Menè P. Acute renal failure due to amiodarone-induced hypothyroidism. Clin Nephrol. 2009;72(1):79-80.

Asami T, Uchiyama M. Elevated serum creatinine levels in infants with congenital hypothyroidism: reflection of decreased renal function? Acta Paediatr. 2000;89(12):1431-4.

Al-Fifi S, Girardin C, Sharma A, Rodd C. Moderate renal failure in association with prolonged acquired hypothyroidism in children. Acta Paediatr. 1999;88(7):715-7.

Iglesias P, Díez JJ. Thyroid dysfunction and kidney disease. Eur J Endocrinol. 2009;160(4):503-15.

Allon M, Harrow A, Pasque CB, Rodriguez M. Renal sodium and water handling in hypothyroid patients: the role of renal insufficiency. J Am Soc Nephrol. 1990;1(2):205-10.

Lee JE, Kim SK, Han KH, Cho MO, Yun GY, Kim KH, et al. Risk factors for developing hyponatremia in thyroid cancer patients undergoing radioactive iodine therapy. PLoS One. 2014;9(8):e106840.