Endothelial Dysfunction as a Factor of Renal Impairment Development in Patients with Hypothyroidism
Introduction. The endothelial dysfunction was found to be detected even within normal range of thyroid-stimulating hormone and it worsens while the growth of thyroid-stimulating hormone levels. The objective of the investigation was to study the condition of the endothelium and its influence on renal function in patients with primary hypothyroidism. Materials and methods. 188 patients with manifested hypothyroidism were examined. They were divided into following groups: group I involved 45 non-obese patients with hypothyroidism on the background of autoimmune thyroiditis; group II included 46 obese patients with autoimmune thyroiditis and hypothyroidism; group III consisted of 47 non-obese patients with post-operative hypothyroidism and group IV consisted of obese patients with postoperative hypothyroidism, n = 50. Results. Investigating endothelial dysfunction in all groups of patients suffering from hypothyroidism, a significant difference in its indices has been revealed, moreover, endothelial dysfunction has appeared to be more pronounced in patients from group II and group IV. Increase in the diameter of the brachial artery after compression in group II and group IV has turned out to be twice less and respectively, endothelium-dependent vasodilation (EDVD) has become 46.4 % and 47.7 % less than the one in healthy people. An inverse correlation of medium strength has been established between thyroid-stimulating hormone and EDVD levels as well as between EDVD and total cholesterol and low-density lipoproteins in a joint group that involved patients with manifested hypothyroidism. The same inverse correlation of medium strength has been revealed in group I and group II; and weak, but positive inverse correlation between vasculoendothelial growth factor and glomerular filtration rate has been established in group III and group IV. Conclusions. Revealed correlations indicate mutually aggravating influence of thyroid hypofunction, obesity and hypercholesterolemia on the development of endothelial dysfunction in patients with primary hypothyroidism and on decrease of glomerular filtration rate. Use of levothyroxine, ACE inhibitor enalapril and atorvastatin in combination significantly improves EDVD.
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