Aims: Thyroid function changes are common endocrine disturbance among patients with chronic kidney disease (CKD), including those receiving renal replacement therapy (RRT). The purpose of the study was to study the effect of RRT on thyroid function in patients with type 1 diabetes (T1D).
Materials and methods: Thyroid hormone examination was performed before and after hemodialysis procedures (HD) in 9 patients with T1D (3 men and 6 women). Mean age was 41.21 ± 11.09 yrs, duration of T1D was 28.17 ± 9.64 yrs, duration of CKD was 12.98 (4.41–14.98) yrs. The terms of receiving RRT were 16.8 (8.25–59.34) months. There was a marked decompensation of T1D (HBA1s 8.28 ± 1.57%). Nonparametric statistical methods were used. A P-value <0.05 was considered significant.
Results: TSH levels were higher after HD, but not statistically significant. FT4 levels before the HD procedure were low normal 12.25 (11.38–13.0) pmol/l and significantly increased towards normalization after HD 15.66 (13.59–16.22). FT3 levels before HD were low 3.75 (3.54–3.83) pmol/l and significantly increased after the HD procedure 4.00 (3.82–4.60), however, stayed in low normal range. Before HD 78% patients had low FT3 and 33% low FT4, changing after HD to 33% of low FT3 to and 11%. FT4. Patients differed by AbTPO (54.51 (12.05–74.74) IU/l vs 19.10 (8.61–55.62). TG was significantly lower after HD (10.37 (6.87–30.84) ng/ml vs 9.71 (5.66–32.68). Despite the fact that the levels of AbTG significantly decreased after HD159.02 (25.11–336.35) IU/l vs 156.80 (51.59–352.90), its median values remained in the diagnostic interval confirming the presence of autoimmunity. Ab-R-TSH were lower after HD (0.3 (0.30–0.65) IU/l vs 0.30 (0.30–0.30). No relationship between thyroid hormones and HbA1c in T1D patients with RRT, as well as between the duration of CKD and RRT with thyroid profile were noted. The age of T1D manifestation correlated with levels of FT3 (ρ = 0.493), AbTPO (ρ = –0.565). Duration of T1D correlates with TG levels (ρ = 0.627).
Conclusion: Revealed changes predetermine the need to assess serum levels of free fractions of peripheral thyroid hormones, as well as hormonal studies immediately after the HD procedure. Low levels of AbTSH-R confirms the absence of influence of autoimmunity on the genesis of thyroid disorders in patients with CKD and RRT.
05 Sep 2020 - 09 Sep 2020