This interesting paper links renal problems to thyroid dysfunction.
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Thyroid Dysfunction and Renal Function: A Crucial Relationship to Recognize
February 2023
Cureus 15(2):e35242 DOI: 10.7759/cureus.35242
Rania Naguib, Eman Elkemary
Background and aim: Renal function is noticeably altered in both hypothyroidism and hyperthyroidism. However, clinical studies on thyroid dysfunction and its association with renal function are scarce. The purpose of this study was to evaluate changes in biochemical parameters of renal function in subjects with thyroid dysfunction and to correlate these values with the patient's thyroid profile. The effect of changes in thyroid function during therapy on renal function was also investigated.
Methods: A prospective cohort study included 41 patients with untreated primary hypothyroidism and 16 patients with untreated hyperthyroidism. Thyroid-stimulating hormone (TSH), free thyroxine, and free triiodothyronine were assessed using immunoassay. The estimated glomerular filtration rate was calculated by the Modification of Diet in Renal Disease formula. Renal function tests were assessed in all patients at each of the two-time points: during thyroid dysfunction (hypo- or hyperthyroidism) and after attaining euthyroidism.
Results: Our study demonstrated a statistically significant reduction in the average serum creatinine level in the hypothyroid patients after treatment compared to before treatment whereas the mean estimated glomerular filtration rate (eGFR) significantly improved after treatment compared to before treatment. Moreover, the average serum creatinine level in the hyperthyroid patients was significantly lower before treatment compared to after treatment, whereas the mean eGFR significantly dropped after treatment. TSH had a significant positive correlation with serum creatinine and a significant negative correlation with eGFR in all patients with thyroid dysfunction.
Conclusions: Thyroid dysfunction is associated with deranged kidney function. It is crucial for the clinician to be aware of the link between thyroid disorders and aberrant renal function in order to consider a thyroid function test when treating a patient whose biochemical markers of renal function are only mildly elevated. There is a need for monitoring creatinine in patients with thyroid dysfunction.
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The GFR is reversibly reduced (by about 40%) in more than 55% of adults with hypothyroidism[40] due to several reasons
…..The earliest and the most common thyroid function abnormality in CKD patients is a low T3 level (especially total T3 than free T3).[53] This “low T3 syndrome” occurs in CKD due to several reasons.
I am down as having stage 3a kidney disease. I have no other symptoms at present other than being overweight and hypothyroidism (Hashimoto’s- pernicious anaemia and coeliac disease) and had kidney scan and have had urine samples taken. all been ok. My creatinine levels are high and out of range.
I have tried a few areas to help reduce and was advised to leave off protein couple days before my blood test also drink more water so well hydrated before blood test but nothing has lowered this area much, and GP has repeatedly called me back to do them, (now get to be expected on test results 🙄) although going on Liothyronine did reduce my level initially I went down to CKD stage 2 although FT3 did decline again 3months down the line even though on Liothyronine… and the creatinine levels crept back to and back to CKD stage 3.
I will know if this has changed in May I’m expecting worse scenario as my FT3 in January was under range (for first time that I know of) and only had an increase in Levothyroxine which I know will do diddly squat🙄
I only noticed the creatinine levels once started on Levothyroxine ironically. I have had annual blood test reviews for many years all doing U&E with creatinine, before I was diagnosed with hypothyroidism as I am asthmatic and take medication for it and nothing was mentioned I can see a few are within range but only a decade of results are online for me to check.
I read a paper linking thyroid with high creatinine and creatine kinase and musculoskeletal pain of which is my main symptom other than blood test level… so I was certain my hypothyroidism is causing hypothyroid myopathy.
CoeliacMum1 does who is prescribing your T3 know that you have had this initial improvement and subsequent decline. I cannot help but feel that the improvement is connected. It is very normal when starting thyroid meds of any kind to feel an initial improvement followed by a decline as your body realises it needs more. I urge you to go to your T3 prescriber and show them the correlation between improved kidney markers and higher FT3, and then the subsequent decline. You may simply need more T3 in your treatment 🙏🏻
My old endocrinologist (retired) had prescribed Liothyronine (T3) and it was mentioned but unfortunately the new endocrinologist took me off … my FT3 levels are now dire and I’m now in a period of let’s wait and see after increasing Levothyroxine 🙄
My review will be mid/late May - if surgery is on time with these things, all the same I’ve booked my bloods for early May already, so I will get results before I speak to anyone regardless - so I will update him by email to his secretary, I’m seeing this endocrinologist privately although he works for NHS too … I’m definitely worse for not have any T3 I feel now 6 months on, but the sense of wellbeing and FT3 levels did plateau after taking it for a year, so I definitely thought give new endocrinologist benefit of doubt, as might not be the answer, this was back in October last year as he suggested my issues could be an adrenal problem as I could have other autoimmune conditions which are messing with things …he ran a Synacthen test and glucose tolerance test and all is good so back to thyroid again and with many endocrinologists chasing TSH this has prevented any increase in T3 I think I’d be best with T3 alone. This endocrinologist hasn’t now ruled out giving me T3 after seeing for himself how poor things are.
Getting through to many of these egotistical medics and one not believing another whilst I’m piggy in the middle suffering 🤨
I feel you on the crappy doctors… sometimes I still can’t believe the mess it all is.
Re. T3, I don’t think T3 only sounds necessary, it sounds like you responded well to T3 being added and when you plateaued into feeling unwell again it may have been a sign you just need more not less/none!
Personally I would self source if I couldn’t get anywhere with the official route. If you have the confidence and understanding to do it then that might be a way of getting around the old crusty crotchety endos.
I’ve travelled hour north & south from my home to see 2 different Endocrinologist via my insurance (my area is rubbish for thyroid endocrinologists as is close by) and I paid privately for T3 prescriptions (Morningside and Mercury brands) at approximately £80 for 20mcg (2months worth) and split tablets taking 10mcg under guidance of endocrinologists which my TSH was at its lowest but my FT3 went down after 6 months on it and then plateaued struggled as soon as off went under range.
I’ve always thought I have hypothyroid myopathy but also being perimenopausal it’s all got blurred into being that being the problem and obviously not helping either way as hrt has helped somewhat … but the kidney part has always triggered me into thinking more thyroid related on reading few papers regarding this area… but these were old papers. I’ve had Creatine kinase (CK) looked at and inflammation markers - CRP & ESP and all ok.
Slightly apprehensive of self prescribing without monitoring as I lost dad 2 yrs ago to heart disease although he was 83 and nearly lost my mum August 2022 (81) she has AFib. Whilst I was taking T3 it did increase my heart rate a bit but was still within normal and I actually lost a bit of weight, so in some ways positive but just been seeing if any other contributing factors before having to go self prescribing route, I would definitely dose to what I know I’m ok with. I’ll be highly surprised if throwing more T4 will do anything for my FT3 (didn’t before)as it’s always sat around 3.6-3.9 highest it’s been was whilst on T3 was 4.2 last spring then started to decline by October was 3.6 , as recall then told to come off it and see if it was an adrenal issue and we’re now back to micromanaging TSH on T4 only but depending how I am he’s willing to look at T3 after this spell of “going back to basics” I am definitely feeling more muscular problems than before but coping unlike early 2020 before pandemic but I’m sure this endocrinologist won’t want my TSH under range either so will titrate until acceptable level.
Chap I’m seeing has thyroid connections with British Thyroid Foundation with research…. So I assumed knowledgeable, my old but retired endocrinologist was on list provided from Thyroid U.K.
I have a name of pro T3 Professor in Oxford which unfortunately I can’t use with health insurance but eventually my health insurance won’t cover this and if I have to self fund to see endocrinologist I’ll give the one above a go.
Absolutely, my only suggestion would be to allow thyroid hormone levels to take precedence over TSH. My own eGFR increased inline with thyroid hormone levels and not TSH, which was and has always remained slightly out of alignment with thyroid hormone levels.
Conclusion mentions the relevence of monitoring creatinine but maybe should also include the elimination of proteinuria that is a common occurance in low thyroid hormone and secretes further thyroid hormone as waste!
Very interesting. When I was first diagnosed with Hashi's, back in 2010, my serum creatinine was raised and eGFR reduced. They returned to normal after my treatment began. For a few years, my annual thyroid function test always included a renal function rest, but the NHS seems to have stopped that - just another way of saving money at the expense of the patient.
I have one kidney. At one point I screamed bloody murder as my GFR dropped eleven points in a very short amount of time.
All I got over and over is "your GGR Iis so great for one kidney".
Insert eye roll.
I said Wonderful.but what does that have to do with an eleven point drop?.And I am not okay with it dropping like that with no explanation.
My GP thought I was crazy. And told me to drink more water before the test.. insert another eye roll.
Or the infamous 'aging does that' line.
I am like aging can of course make a GFR drop but 11 points out of the blue?
After my thyroidectomy, and thyroid hormones given, it went back up. I did not have a thyroidectomy due to a diseased thyroid but it came out diseased (another on it was just aging line again - I am not old). And although I am not at a place of level thyroid hormones, I can feel what I had been missing for years in my body.
It is so aggravating when you know your own body and quite frankly have common sense and can not get through to them. I asked my gynaecologist of all people "Is it normal for a GFR to drop eleven points in under a year for no reason or 'aging'?
Nope. Not at all.
Thank you for the paper. And thank you for the vent.
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Interesting article: mild TSH suppression gives closest to normal thyroid function in levothyroxine monotherapy for this group
