scholarly journals Preservation of Renal Function by Thyroid Hormone Replacement Therapy in Chronic Kidney Disease Patients with Subclinical Hypothyroidism

2012 ◽  
Vol 97 (8) ◽  
pp. 2732-2740 ◽  
Author(s):  
Dong Ho Shin ◽  
Mi Jung Lee ◽  
Seung Jun Kim ◽  
Hyung Jung Oh ◽  
Hyoung Rae Kim ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Hormone Replacement Therapy ◽  
Thyroid Hormone ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Subclinical Hypothyroidism ◽  
Hormone Replacement ◽  
Renal Outcome ◽  
Thyroid Hormone Replacement ◽  
Thyroid Hormone Replacement Therapy

Abstract Context: Subclinical hypothyroidism is not a rare condition, but the use of thyroid hormone to treat subclinical hypothyroidism is an issue of debate. Objective: This study was undertaken to investigate the impact of thyroid hormone therapy on the changes in estimated glomerular filtration rate (eGFR) in subclinical hypothyroidism patients with stage 2–4 chronic kidney disease. Patients: A total of 309 patients were included in the final analysis. Main Outcome Measure: The changes in eGFR over time were compared between patients with and without thyroid hormone replacement therapy using a linear mixed model. Kaplan-Meier curves were constructed to determine the effect of thyroid hormone on renal outcome, a reduction of eGFR by 50%, or end-stage renal disease. The independent prognostic value of subclinical hypothyroidism treatment for renal outcome was ascertained by multivariate Cox regression analysis. Results: Among the 309 patients, 180 (58.3%) took thyroid hormone (treatment group), whereas 129 (41.7%) did not (nontreatment group). During the mean follow-up duration of 34.8 ± 24.3 months, the overall rate of decline in eGFR was significantly greater in the nontreatment group compared to the treatment group (−5.93 ± 1.65 vs. −2.11 ± 1.12 ml/min/yr/1.73 m2; P = 0.04). Moreover, a linear mixed model revealed that there was a significant difference in the rates of eGFR decline over time between the two groups (P < 0.01). Kaplan-Meier analysis also showed that renal event-free survival was significantly lower in the nontreatment group (P < 0.01). In multivariate Cox regression analysis, thyroid hormone replacement therapy was found to be an independent predictor of renal outcome (hazard ratio, 0.28; 95% CI, 0.12–0.68; P = 0.01). Conclusion: Thyroid hormone therapy not only preserved renal function better, but was also an independent predictor of renal outcome in chronic kidney disease patients with subclinical hypothyroidism.

scholarly journals Echocardiographic Evaluation of Diastolic Dysfunction in Patients with Subclinical Hypothyroidism & the effect of L-Thyroxine treatment: A hospital based study

2014 ◽  
Vol 11 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Prahlad Karki ◽  
Ila Pandey ◽  
Sangita Bhandary ◽  
Madhab Lamsal ◽  
Nikesh Raj Shrestha
Keyword(s):  
Hormone Replacement Therapy ◽  
Thyroid Hormone ◽  
Pericardial Effusion ◽  
Diastolic Dysfunction ◽  
Replacement Therapy ◽  
Subclinical Hypothyroidism ◽  
Hormone Replacement ◽  
Thyroid Function Tests ◽  
Thyroid Hormone Replacement ◽  
Thyroid Hormone Replacement Therapy

Background & Aims: Diastolic dysfunction is the common condition with Subclinical Hypothyroidism and is reversible in many cases after treatment. We aimed to investigate the response of diastolic dysfunction to thyroid hormone replacement therapy in patients of Subclinical Hypothyroidism. Methods: Forty newly diagnosed cases of Subclinical Hypothyroidism (38 females and 2 males) and age more than 18 years were included. Diagnosis was made on the basis of history, clinical examination and thyroid function tests. Echocardiography was performed in all and was repeated after 4-6 months in those who had diastolic dysfunction. Distribution of Diastolic dysfunction among the involved cases and their response to treatment with L-thyroxine were studied. Results: The diastolic dysfunction was found in 15 (37.5%) and pericardial effusion (PE) in five (12.5%) patients. Fourteen of them had impaired relaxation abnormality and only one patient had pseudonormal pattern. With replacement therapy, 13 reverted back to the normal whereas one having grade 2 diastolic dysfunction (pseudonormal pattern) reverted to grade 1. One patient who had grade 1 diastolic dysfunction (impaired relaxation) did not improve. Pericardial effusion subsided in all 5 cases. Conclusions: Echocardiography may be a useful tool for monitoring the response of diastolic dysfunction to thyroid hormone replacement therapy in patients with Subclinical Hypothyroidism. Our findings suggest that Thyroid Hormone Replacement Therapy may reverse diastolic dysfunction in Subclinical Hypothyroidism. DOI: http://dx.doi.org/10.3126/njh.v11i1.10979   Nepalese Heart Journal 2014;11(1): 33-38

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