Thyroid hormone replacement therapy attenuates decline of renal function in chronic kidney disease patients with subclinical hypothyroidism.

[helvella]

The idea that so-called sub-clinical hypothyroidism should not be treated keeps getting questioned by research papers. In this case, those with kidney disease and sub-clinical hypothyroidism seem to do better when treated.

It does make me wonder what the impact of not treating over long periods has? Could it even be a cause of some kidney disease, or at least, deterioration in function?

If your estimated Glomerular Filtration Rate (often abbreviated eGFR in tests) is low, maybe you need to think about this paper?

Thyroid. 2013 Jan 2. [Epub ahead of print]

Thyroid hormone replacement therapy attenuates the decline of renal function in chronic kidney disease patients with subclinical hypothyroidism.

Shin DH, Lee MJ, Lee HS, Oh HJ, Ko KI, Kim CH, Doh FM, Koo HM, Kim HR, Han JH, Park JT, Han SH, Yoo TH, Kang SW.

Source

Kangdong Sacred Heart Hospital, Hallym University College of Medicine , Department of Internal Medicine, 445 Gil-Dong, Kang Dong-Gu, Seoul, Korea, Republic of, 134-701, 82-2-2224-2868; [e-mail].

Abstract

Background:

Subclinical hypothyroidism (SH) is not a rare condition in females, the elderly, or patients with chronic kidney disease (CKD). Even though previous studies have demonstrated that thyroid hormone replacement therapy (THRT) improved cardiac function and dyslipidemia in patients with subclinical hypothyroidism, it remains unclear as to whether THRT can improve renal function in CKD patients with SH. This study investigated the impact of THRT on changes in estimated glomerular filtration rates (eGFR) in this patient population.

Methods:

A total of 113 CKD patients with SH who were treated with L-thyroxine and had eGFR available for at least 24 months before and after THRT were enrolled between January 2005 and December 2011. A linear mixed model was used to compare patients' clinical and biochemical parameters at various time points. The slope of the decline in eGFR over time, both before and after THRT, was also calculated and compared using a linear mixed model.

Results:

The mean age of the study participants was 63.2 ± 12.7 years, and 36 patients (31.9%) were male. The mean follow-up duration before and after THRT was 28.6 ± 4.5 and 30.6 ± 6.4 months, respectively. At 24-months of THRT, TSH levels were significantly reduced [8.86 (0.49) vs. 1.41 (0.73) ?IU/mL, P < 0.001], but there were no significant changes in T3 and fT4 concentrations. Serum albumin, calcium, phosphate, cholesterol, and triglyceride levels were also comparable after THRT. The rates of decline in eGFR were significantly attenuated by THRT [-4.31 (0.51) vs. -1.08 (0.36) mL/min/year/1.73 m2, P < 0.001] even after adjustment for age, gender, diabetes, mean arterial pressure, serum albumin, cholesterol, and triglyceride concentrations (P < 0.001).

Conclusion:

THRT attenuated the rate of decline in renal function in CKD patients with SH, suggesting that THRT may delay reaching end-stage renal disease in these patients.

PMID:

23281965

ncbi.nlm.nih.gov/pubmed/232...

Rod

[PinkNinja]

Another interesting paper. I wouldn't be surprised if a lot of these diseases and illnesses can be attributed, at least in part, to inadequate thyroid function.

As I speak, I am sitting here with a regular pulse for the first time in at least 10 years, probably longer. It is still rather slow but it is regular. Three cardiologists failed to work out the reason for my arrhythmia, bradycardia, ectopic beats and completely dropped beats (sometimes several in a row!) They could see what was happening but, after numerous tests, could find no reason as to why. My GP wanted to refer me again a couple of months ago but I said there was no point and explained what the previous cardiologist appointments had revealed. Since my thyroid treatment changes, I seem to be having significant periods of regular pulse and my resting pulse is now into the 50's (just) compared with the high 30's last year! Coincidence? Possibly, but I don't think so.

Carolyn x

[helvella Administrator in reply to PinkNinja]

I so agree.

I can't help feeling that you should have another appointment with the same cardios so that they can see for themselves what impact thyroid treatment has had. They might then understand a bit more and handle future patients differently. What is evidence-based medicine if it doesn't collect and interpret the evidence? (Yes - I also know why that is not likely to happen! And far too much wishful thinking.)

[PinkNinja in reply to helvella]

I know But I will be making this a very big point when I next see my GP, along with the fact my ?RA seems to have improved immensely. Hopefully my cholesterol has come down too.

[PR4NOW in reply to PinkNinja]

CarolynB, thyroid and adrenals are both heart related. It is good you are doing so much better. PR

[PR4NOW]

Rod, I have always had a difficult time with the concept of subclinical hypothyroidism as defined the the TSH test. I feel it is an artificial construct and not terribly relevant to 'real world endocrinology'. I suspect we will see similiar results for other conditions. Thanks for the article. PR

[helvella Administrator in reply to PR4NOW]

Not only that, the term is often misused.

Some definitions say that the person should have NO symptoms whereas that is often clearly not the case.

Some definitions say that FT4 (and at least imply, FT3) must be in range. Whereas they are often not tested.

With terms like this, we need one universal, authoritative definition. Whilst I fundamentally disagree with what they say about IBS, the gastroenterologists do keep updating definitions so we have "IBS according to Rome 2" or whatever.

[Hidden in reply to PR4NOW]

Yippee! More evidence to thrown in the face of doctors who refuse to treat "subclinical" patients. Thanks Rod for posting. I agree PR, the term subclinical really hacks me off. Makes it sound like it's not a clinical problem and when you feel like absolute cr*p that does NOT go down well! Hopefully things are getting there, slowly but surely.

[valerie]

I am pretty certain my mother was hypo.(all us children are) as she had so many symptoms though she was never tested or treated and I was ignorant at the time. I never understood why she also had chronic kidney disease for the last few years of her life and put it down to diuretics for high BP. She also had to have blood transfusions etc. for anaemia and took vast amounts of painkillers. How I wish I had known then what I know now but mum rarely complained and actually lived quite well until she was almost 93. I am thinking that had she had her thyroid looked at and been treated then she would not have had chronic kidney disease, heart failure, high blood pressure, anaemia, painful joints and hair loss and other things.....Val

[Hidden]

Sorry Rod, went off on a bit of a subclinical rant which I thought I should probably delete :-s !!!

[helvella Administrator in reply to Hidden]

Don't worry - I agree.