Thyroid function in patients with type 1 diabetes mellitus and chronic kidney disease receiving renal replacement therapy
Keywords:type 1 diabetes mellitus, thyroid gland, renal replacement therapy, chronic kidney disease
Background. Impaired thyroid function is a common endocrine pathology among patients with chronic kidney disease (CKD), including those receiving renal replacement therapy. The results of the Third National Health and Nutrition Examination Survey demonstrated that the proportion of patients with hypothyroidism rises to 23 % in progressive impaired renal function. The purpose was to study the effect of renal replacement therapy on the thyroid function in patients with type 1 diabetes mellitus and CKD. Materials and methods. We assessed thyroid function in 155 diabetic patients with end-stage CKD in a cross-sectional study. When assessing the functional status of the thyroid gland, the calculated indicators were used: the peripheral conversion index and the integral thyroid index. Peripheral conversion index was calculated as the ratio of free T4 to free T3. Results. No significant differences were found between the groups of patients receiving renal replacement therapy and patients with type 1 diabetes mellitus with and without comorbid CKD in terms of total T4 and T3, thyroglobulin, thyroglobulin antibodies and thyroid peroxidase antibodies. Significantly lower rates of free T4 and free T3 were noted with a maximum decrease when receiving renal replacement therapy. A significant decrease in the levels of thyroid-stimulating hormone receptor antibodies confirms the absence of influence of autoimmunity on the origin of thyroid disorders in patients with CKD receiving renal replacement therapy. No relationship was found between the thyroid hormones and HbA1c in type 1 diabetes mellitus patients receiving renal replacement therapy, as well as between the duration of CKD and renal replacement therapy and thyroid profile. Conclusions. These changes predetermine the need to assess serum levels of free fractions of peripheral thyroid hormones, as well as hormonal studies immediately after the hemodialysis procedure.
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