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慢性肾病患者的甲状腺功能

Authors
Biff F Palmer, MD
William L Henrich, MD, MACP
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD
Translators
刘章锁, 主任医师，教授

引言

正常情况下，肾脏在几种甲状腺激素的代谢、降解和排泄过程中发挥着重要作用。因此，肾功能损害会导致甲状腺生理的紊乱就不足为奇了。这可能涉及下丘脑-垂体-甲状腺轴的所有层面，包括激素的合成、分布和排泄的改变。 (参见“甲状腺激素的合成和生理学”)

因此，尿毒症患者经常出现甲状腺功能检测异常。然而，尿毒症综合征和甲状腺功能减退的症状有所重叠，所以需要谨慎地解读这些检测。不过，对于每个尿毒症患者，通过检体诊断和甲状腺功能检测通常可以准确评估甲状腺的状态。

流行病学资料显示，透析前慢性肾病患者发生甲状腺功能减退的风险增加[1,2]。很多情况下这种减退是亚临床的。

肾病综合征中甲状腺激素代谢的改变和非甲状腺疾病中甲状腺功能的一般问题将在别处讨论。 (参见“肾病综合征的内分泌功能异常”和“非甲状腺疾病中的甲状腺功能”)

甲状腺激素代谢

正常情况下，肾脏主要通过肾小球滤过作用促进碘的排泄。因此，在肾功能衰竭晚期碘的排泄减少，从而导致血浆无机碘浓度升高和一个初始的甲状腺碘摄取增加。随后尿毒症患者的甲状腺内碘池显著增加导致甲状腺摄取放射性标记的碘减少[3]。体内总无机碘增加可以阻止甲状腺激素合成(Wolff-Chaikoff效应)。这种变化或许可以解释为什么慢性肾脏疾病患者中甲状腺肿和甲状腺功能减退的发生率略高[4]。

      

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-07.
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