Thyroid function in chronic kidney disease
- Biff F Palmer, MD
Biff F Palmer, MD
- Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- William L Henrich, MD, MACP
William L Henrich, MD, MACP
- Professor of Medicine
- President of the Health Science Center
- University of Texas Health Science Center School of Medicine
The kidney normally plays an important role in the metabolism, degradation, and excretion of several thyroid hormones. It is not surprising, therefore, that impairment in kidney function leads to disturbed thyroid physiology. All levels of the hypothalamic-pituitary-thyroid axis may be involved, including alterations in hormone production, distribution, and excretion. (See "Thyroid hormone synthesis and physiology".)
As a result, abnormalities in thyroid function tests are frequently encountered in uremia. However, the overlap in symptomatology between the uremic syndrome and hypothyroidism requires a cautious interpretation of these tests. Nevertheless, it is ordinarily possible in the individual uremic patient to assess thyroid status accurately by physical diagnosis and thyroid function testing.
Epidemiologic data suggest that predialysis patients with chronic kidney disease have an increased risk of hypothyroidism [1,2]. Many cases are subclinical.
The changes in thyroid hormone metabolism that occur in the nephrotic syndrome and the general issue of thyroid function in nonthyroidal illness are discussed elsewhere. (See "Endocrine dysfunction in the nephrotic syndrome" and "Thyroid function in nonthyroidal illness".)
THYROID HORMONE METABOLISM
The kidney normally contributes to the clearance of iodide, primarily by glomerular filtration. Thus, iodide excretion is diminished in advanced renal failure, leading sequentially to an elevated plasma inorganic iodide concentration and an initial increment in thyroidal iodide uptake. The ensuing marked increase in the intrathyroidal iodide pool results in diminished uptake of radiolabeled iodide by the thyroid in uremic patients . Increases in total body inorganic iodide can potentially block thyroid hormone production (the Wolff-Chaikoff effect). Such a change may explain the slightly higher frequency of goiter and hypothyroidism in patients with chronic kidney disease .
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