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BK Barik, RC Sethy, S Tripathy, B Pradhan, AK Surin, SR Pattnaik, P Das
AIMS
OF THE
STUDY:
To
estimate
Serum T3,
T4TSH
in
patients
of
Chronic
Renal
failure
with
special
reference
to (a)
Biochemcial
abnormalities
of
thyroid
functions
in CRF(b)
To
correlate
between
severity
of CRF
and
alteration
of
thyroid
indices
(c)
Effect
of
conservative
management
vs
haemodialysis
on
thyroid
indices.
MATERIALS
AND
METHODS:
Twenty
cases of
CRF
patients
admitted
to
Department
of
Medicine
and
Nephrology,
V.S.S.
Medical
College
Hospital
Burla
from
January
2003-December
2003
were
taken
for the
study.
CRF was
diagnosed
by the
criteria
given by
“Harrison’s
Principles
of
Internal
Medicine,
Edn 15th.
Individuals
with
known
thyroid
disease
and
those on
antithyroid
drugs,
iodine
intake
were not
included
in the
study.
Serum T3,
T4,
TSH and
free T3,
T4
was done
in all
patients
on
admission
and
repeated
at 3rd
, 6th
and 12th
months
during
follow
up and
results
were
compared.
Severity
of renal
failure
was
grouped
according
to GFR
and the
value of
T3,
T4,
TSH was
compared
between
groups.
OBSERVATION:
Out of
20 CRF
patients
in this
study,
male
(80%)
commonest
presenting
features
anorexia
(80%),
puffiness
on face
(70%),
oliguria
(50%).
All
patients
were
anaemic
, 70%
had
hypertension.
Commonest
vause of
CRF was
diabetes
(50%),
hypertension
(20%),
chronic
glomerulonephritis
(10%),
chronic
pylonephritis
(5%). No
cause
found in
15%. TSH
was
normal
in 17
cases.
Only 3
cases
had
increased
TSH. 16
cases
had low
T3,
13 cases
normal
T4,
only 7
cases
had
increased
T4.
No
significant
improvement
in T3,
T4,
TSH was
seen in
aptietns
receiving
conservative
management.
However
haemodialysis
reverted
the
abnormality
partially.
Severity
of renal
failure
and
thyroid
dysfunction
with
respect
to T3
was
found to
be
significant.
CONCLUSION:
From the
study it
can be
presumed
that,
there
occurs a
state of
biochemical
hypothyroidism
in
patients
of CRF
and
extent
of
thyroid
dysfunction
depends
upon the
severity
of renal
failure.
The low
T3
is not
due to
increased
T3
degradation
or
decreased
T3
secretion,
but as a
result
of
impaired
extrathyroidal
T4
to T3
conversion.
The
reduction
in T4
s due to
presence
of
circulating
inhibitors
which
impair
binding
of T4
to
thyroxin
binding
globulin.
Conservative
management
does not
improve
thyroid
status
through
haemodilysis
partially
reverts
back the
abnormality. |
