The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Prevalence of Hypothyroidism in Patients with Chronic Kidney Disease

만성 신질환 환자에서의 갑상선 기능 저하증 빈도

  • Lee, Da-Hyen (Department of Nephrology, National Medical Center) ;
  • Jeon, Young-Deok (Department of Nephrology, National Medical Center) ;
  • Lee, Seung-Hun (Department of Nephrology, National Medical Center) ;
  • Mun, Ga-Seul (Department of Nephrology, National Medical Center) ;
  • Na, Su-Sie (Department of Nephrology, National Medical Center) ;
  • Cha, Huk-Hwan (Department of Nephrology, National Medical Center)
  • Published : 2011.09.01
⟨ Previous Next ⟩

Abstract

Background/Aims: Primary thyroid disease is prevalent in chronic renal disease, especially in patients requiring chronic dialysis. However, the relationship between kidney function and the prevalence of primary thyroid disease has not been studied in Korea, a nation where the dietary iodine intake is excessive. Methods: Retrospective data from 2201 consecutive adult patients who visited a health promotion center over the last 5 years were analyzed; specifically, 54 patients with chronic kidney disease not requiring hemodialysis and 64 adults treated with hemodialysis. The glomerular filtration rate (GFR) was estimated using the abbreviated Modification of Diet in Renal Disease equation. Multivariable logistic regression was used to evaluate the independent association between the prevalence of primary hypothyroidism and estimated GFR. Results: The prevalence of overt hypothyroidism increased from 0.5% at an estimated GFR > 90 mL/min/$1.73\;m^{2}$ to 6.3% in end-stage renal disease requiring chronic dialysis (p < 0.001 for trend). Compared with participants with an estimated GFR > 60 mL/min/$1.73\;m^{2}$, those with an estimated GFR < 60 mL/min per $1.73\;m^{2}$ had an increased odds of overt hypothyroidism after adjusting for age, gender, fasting blood glucose (FBS), and the total cholesterol (TC) and triglyceride (TG) concentrations. Conclusions: These findings suggest that overt primary hypothyroidism is relatively common (6.3%) among persons with chronic kidney disease requiring chronic dialysis, and it is independently associated with a progressively lower estimated GFR.

목적: 만성 신장 질환에서 원발성 갑상선 질환(갑상선 기능 저하증, 갑상선 결절, 갑상선종, 갑상선암) 빈도가 정상인보다 높다는 사실은 여러 역학 조사에서 이미 밝혀진 바 있다. 하지만 아이오딘 과다 섭취국 중 하나인 한국에서 신장 기능과 원발성 갑상선 질환 빈도의 정확한 관계는 아직까지 연구된 바 없다. 방법: 2007년 1월부터 2010년 6월까지 국립중앙의료원 건강증진센터를 통해 검진 받은 2201명, 2008년 5월부터 2011년 5월까지 외래에서 진료를 보았던 투석을 요하지 않는 만성 신질환 환자 54명, 2010년 국립중앙의료원 인공 신장실에서 투석을 받고 있는 64명을 대상으로 하여 추정 사구체 여과율(MDRD-estimated glomerular filtration rate)에 따른 갑상선 기능 저하증의 빈도를 구하였다. 원발성 갑상선 기능 저하증과 신기능의 정확한 관계는 이변량 로지스틱 회귀 분석을 통하여 구하였다. 결과: 명백한 갑상선 기능 저하증 빈도는 GFR > 90 mL/min/1.73 $m^2$ 환자에서 0.5%, 투석을 요하는 만성 신부전 환자에서 6.3%로 증가하는 양상을 보였으며 또한 다변량 로지스틱 회귀 분석 결과 만성 신질환 환자에서 9.002의 오즈비를 보였다. 결론: 명백한 갑상선 기능 저하증의 빈도는 투석을 요하는 신부전 환자에서 흔하며 신기능 감소에 따라 증가한다.

Keywords

References

  1. Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139:137-147. https://doi.org/10.7326/0003-4819-139-2-200307150-00013
  2. U.S. Renal Data System. USRDS 2009 annual data report: Atlas of chronic kidney disease and end-stage renal disease in the United States. Bethesda: National Institute of Diabetes and Digestive and Kidney Diseases, 2007.
  3. Kiberd B. The chronic kidney disease epidemic: stepping back and looking forward. J Am Soc Nephrol 2006;17:2967-2973. https://doi.org/10.1681/ASN.2006020123
  4. Amato AA, Santos GM, Neves F de A. Thyroid hormone action in chronic kidney disease. Curr Opin Endocrinol Diabetes Obes 2008;15:459-465, doi: 10.1097/MED.0b013e32830eb85e.
  5. Kaptein EM, Quion-Verde H, Chooljian CJ, et al. The thyroid in end-stage renal disease. Medicine (Baltimore) 1988;67:187-197. https://doi.org/10.1097/00005792-198805000-00005
  6. Lo JC, Chertow GM, Go AS, Hsu CY. Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease. Kidney Int 2005;67:1047-1052. https://doi.org/10.1111/j.1523-1755.2005.00169.x
  7. Song IS, Kim KH, Oh SJ, Jung HS, Lee JH, Yoon KI. The effects of hemodialysis and kidney transplantation on the thyroid function in patients with chronic renal failure. Korean J Med 1996;51:79-87.
  8. Lee HH, Kim DJ, Kim JA, et al. Change of the thyroid function in continuous ambulatory peritoneal dialysis patients. Korean J Nephrol 2003;22:96-101.
  9. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T (4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-499. https://doi.org/10.1210/jc.87.2.489
  10. Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease, scientific review and guidelines for diagnosis and management. JAMA 2004;291:228-238. https://doi.org/10.1001/jama.291.2.228
  11. Wilson GR, Curry RW Jr. Subclinical thyroid disease. Am Fam Physician 2005;72:1517-1524.
  12. Garber JR, Hennessey JV, Lieberman JA 3rd, Morris CM, Talbert RL. Clinical update: managing the challenges of hypothyroidism. J Fam Pract 2006;55:S1-S8.
  13. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado Thyroid Disease Prevalence Study. Arch Intern Med 2000;160:526-534. https://doi.org/10.1001/archinte.160.4.526
  14. Tunbridge WM, Evered DC, Hall R, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf) 1977;7:481-493. https://doi.org/10.1111/j.1365-2265.1977.tb01340.x
  15. Schectman JM, Kallenberg GA, Shumacher RJ, Hirsch RP. Yield of hypothyroidism in symptomatic primary care patients. Arch Intern Med 1989;149:861-864. https://doi.org/10.1001/archinte.1989.00390040075015
  16. Helfand M, Crapo LM. Screening for thyroid disease. Ann Intern Med 1990;112:840-849. https://doi.org/10.7326/0003-4819-112-11-840
  17. Bagchi N, Brown TR, Parish RF. Thyroid dysfunction in adults over age 55 years: a study in an urban US community. Arch Intern Med 1990;150:785-787. https://doi.org/10.1001/archinte.1990.00390160053012
  18. Sawin CT, Chopra D, Azizi F, Mannix JE, Bacharach P. The aging thyroid. Increased prevalence of elevated serum thyrotropin levels in the elderly. JAMA 1979;242:247-250. https://doi.org/10.1001/jama.1979.03300030019013
  19. Papi G, Uberti ED, Betterle C, et al. Subclinical hypothyroidism. Curr Opin Endocrinol Diabetes Obes 2007;14:197-208. https://doi.org/10.1097/MED.0b013e32803577e7
  20. Ripoli A, Pingitore A, Favilli B, et al. Does subclinical hypothyroidism affect cardiac pump performance? Evidence from a magnetic resonance imaging study. J Am Coll Cardiol 2005;45:439-445. Erratum in: J Am Coll Cardiol 2005;45:968. https://doi.org/10.1016/j.jacc.2004.10.044
  21. Lim VS. Thyroid function in patients with chronic renal failure. Am J Kidney Dis 2001;38(4 Suppl 1):S80-S84.
  22. Zoccali C, Tripepi G, Cutrupi S, Pizzini P, Mallamaci F. Low triiodothyronine: a new facet of inflammation in end stage renal disease. J Am Soc Nephrol 2005;16:2789-2795. https://doi.org/10.1681/ASN.2005040356
  23. Zoccali C, Benedetto F, Mallamaci F, et al. Low triiodothyronine and cardiomyopathy in patients with end stage renal disease. J Hypertens 2006;24:2039-2046. https://doi.org/10.1097/01.hjh.0000244954.62362.8f
  24. Zoccali C, Mallamaci F, Tripepi G, Cutrupi S, Pizzini P. Low triiodothyronine and survival in end-stage renal disease. Kidney Int 2006;70:523-528.
  25. Carrero JJ, Qureshi AR, Axelsson J, et al. Clinical and biochemical implications of low thyroid hormone levels (total and free forms) in euthyroid patients with chronic kidney disease. J Intern Med 2007;262:690-701. https://doi.org/10.1111/j.1365-2796.2007.01865.x
  26. Bando Y, Ushiogi Y, Okafuji K, Toya D, Tanaka N, Miura S. Non-autoimmune primary hypothyroidism in diabetic and non-diabetic chronic renal dysfunction. Exp Clin Endocrinol Diabetes 2002;110:408-415 https://doi.org/10.1055/s-2002-36427
  27. Sanai T, Inoue T, Okamura K, et al. Reversible primary hypothyroidism in Japanese patients undergoing maintenance hemodialysis. Clin Nephrol 2008;69:107-113.
  28. Chonchol M, Lippi G, Salvagno G, Zoppini G, Muggeo M, Targher G. Prevalence of subclinical hypothyroidism in patients with chronic kidney disease. Clin J Am Soc Nephrol 2008;3:1296-1300. https://doi.org/10.2215/CJN.00800208