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Subclinical hypothyroidism was common among patients with CKD
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Subclinical hypothyroidism was a relatively common condition among patients with chronic kidney disease not requiring chronic dialysis and was independently associated with a progressively lower estimate glomerular filtration rate, according to recent data.
The researchers from the University of Colorado Health Sciences Center in Denver and the University Hospital of Verona in Italy analyzed data from 3,089 outpatients who were referred for blood testing during the past two years.
Of these patients, 9.5% had subclinical hypothyroidism and 9% had an eGFR of <60 mL per minute per 1.73 m2.
According to the researchers, the prevalence of subclinical primary hypothyroidism increased from 7% in those patients who had an eGFR of ≥90 mL per minute per 1.73 m2 to 17.9% at an eGFR of <60 mL per minute per 1.73 m2 (P<.0001).
Patients with an eGFR of <60 mL per minute per 1.73 m2 had increased odds for subclinical primary hypothyroidism when adjusted and compared with patients with an eGFR of ≥60 mL per minute per 1.73 m2, according to the researchers. – by Christen Haigh
Clin J Am Soc Nephrol. 2008;doi:10.2215/CJN.00800208.
In this large group of Italian adult outpatients, there was an increased incidence of subclinical hypothyroidism in those with reduced renal function (eGFR<60 mL per minute per 1.73 m2). The association of an increase in thyroid-stimulating hormone with reduced renal function is convincing, but the etiology was not directly studied. A greater incidence of subclinical hypothyroidism in women would be expected if the predominant cause was autoimmune thyroid disease, but no effect of sex was observed. Iodine intake is reduced in some areas of Italy and may have been a factor in these patients. Renal insufficiency may also influence the reliability of thyroid function tests. The elevation in serum lipids reported in those patients with subclinical hypothyroidism, however, suggests reduced thyroid hormone action. Although further studies that include measurement of iodine intake and thyroid antibodies are needed, reduced renal function appears to be a risk factor for subclinical hypothyroidism, and there should be a low threshold to test thyroid function in these patients.
– Gregory Brent, MD
Endocrine Today Editorial Board member