Journal of Yeungnam Medical Science

영남대 의대 학술지 편집위원회 (Yeungnam University College of Medicine, Yeungnam University Institute Medical Science)
권호 표지
DOI QR코드

DOI QR Code

혈액투석 환자에서 갑상선 초음파의 추적

Follow-up of thyroid ultrasonography in patients with hemodialysis

  • 김현정 (경상대학교 의학전문대학원 내과학교실) ;
  • 김보라 (경상대학교 의학전문대학원 내과학교실) ;
  • 서영미 (경남과학기술대학교 간호학과) ;
  • 조윤영 (경상대학교 의학전문대학원 내과학교실) ;
  • 백종하 (창원경상대학교병원 내분비대사내과) ;
  • 김경영 (창원경상대학교병원 내분비대사내과) ;
  • 김수경 (경상대학교 의학전문대학원 내과학교실) ;
  • 우승훈 (경상대학교 건강과학연구원) ;
  • 정정화 (경상대학교 의학전문대학원 내과학교실) ;
  • 정재훈 (경상대학교 건강과학연구원) ;
  • 함종렬 (경상대학교 의학전문대학원 내과학교실)
  • Kim, Hyun-Jung (Department of Internal Medicine, Gyeongsang National University School of Medicine) ;
  • Kim, Bo Ra (Department of Internal Medicine, Gyeongsang National University School of Medicine) ;
  • Seo, Yeong-Mi (Department of Nursing, Gyeongnam National University of Science and Technology) ;
  • Cho, Yoon Young (Department of Internal Medicine, Gyeongsang National University School of Medicine) ;
  • Baek, Jong-Ha (Division of Endocrinology and Metabolism, Department of Internal Medicine, Gyeongsang National University Changwon Hospital) ;
  • Kim, Kyong Young (Division of Endocrinology and Metabolism, Department of Internal Medicine, Gyeongsang National University Changwon Hospital) ;
  • Kim, Soo-Kyung (Department of Internal Medicine, Gyeongsang National University School of Medicine) ;
  • Woo, Seung-Hoon (Institute of Health Sciences, Gyeongsang National University) ;
  • Jung, Jung Hwa (Department of Internal Medicine, Gyeongsang National University School of Medicine) ;
  • Jung, Jaehoon (Institute of Health Sciences, Gyeongsang National University) ;
  • Hahm, Jong Ryeal (Department of Internal Medicine, Gyeongsang National University School of Medicine)
  • 투고 : 2017.05.26
  • 심사 : 2017.06.12
  • 발행 : 2017.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Chronic kidney disease is considered a risk factor for thyroid nodules as well as thyroid dysfunction such as hypothyroidism. Among patients on hemodialysis, we assessed the size of thyroid nodule and goiter at baseline and 1 year later with ultrasonography. Methods: We prospectively selected 47 patients with hemodialysis at January 2012 and reviewed their medical records. We checked goiter and thyroid nodules at January 2012 and December 2012. Results: In the hemodialysis patients (n=47), 24 patients (51.1%) had thyroid nodules and 33 patients (70.2%) had goiter at baseline. Parathyroid hormone (PTH) was higher in patients with thyroid nodules ($204.4{\pm}102.9$ vs. $129.9{\pm}93.6pg/mL$, p=0.01). Thyroid ultrasonography was conducted in 29 patients after 1 year. The thickness of the thyroid isthmus increased ($2.8{\pm}1.6$ vs. $3.2{\pm}1.9mm$, p=0.003), but the number of nodules did not change ($1.2{\pm}1.9$ vs. $1.4{\pm}2.0$, p=0.109). PTH was associated with the enlargement of thyroid nodules significantly through logistic regression analysis. Conclusion: Thyroid goiter and nodules in hemodialysis patients were more prevalent than in the general population. PTH influenced the production of thyroid nodules in hemodialysis patients. Regular examination with thyroid ultrasonography and thyroid function test should be considered in hemodialysis patients.

키워드

참고문헌

  1. Kaptein EM, Feinstein EI, Massry SG. Thyroid hormone metabolism in renal diseases. Contrib Nephrol 1982;33:122-35.
  2. Kaptein EM, Quion-Verde H, Chooljian CJ, Tang WW, Friedman PE, Rodriquez HJ, et al. The thyroid in end-stage renal disease. Medicine (Baltimore) 1988;67:187-97. https://doi.org/10.1097/00005792-198805000-00005
  3. Hegedüs L, Andersen JR, Poulsen LR, Perrild H, Holm B, Gundtoft E, et al. Thyroid gland volume and serum concentrations of thyroid hormones in chronic renal failure. Nephron 1985;40:171-4. https://doi.org/10.1159/000183455
  4. Lin CC, Chen TW, Ng YY, Chou YH, Yang WC. Thyroid dysfunction and nodular goiter in hemodialysis and peritoneal dialysis patients. Perit Dial Int 1998;18:516-21.
  5. Ramírez G, Jubiz W, Gutch CF, Bloomer HA, Siegler R, Kolff WJ. Thyroid abnormalities in renal failure. A study of 53 patients on chronic hemodialysis. Ann Intern Med 1973;79:500-4. https://doi.org/10.7326/0003-4819-79-4-500
  6. Sanai T, Okamura K, Inoue T, Abe T, Tsuruya K, Node K. Ultrasonographic detection of thyroid nodules in hemodialysis patients in Japan. Ther Apher Dial 2010;14:323-7. https://doi.org/10.1111/j.1744-9987.2010.00810.x
  7. Kaptein EM, Quion-Verde H, Massry SG. Hemodynamic effects of thyroid hormone. Contrib Nephrol 1984;41:151-9.
  8. Jusufovic S, Hodzic E, Halilcevic A. Role of renal anemia in the functional, morphological and autoimmune thyroid disorders in patients on chronic hemodialysis. Med Arh 2011; 65:228-32. https://doi.org/10.5455/medarh.2011.65.228-232
  9. Lin CC, Yang WC, Ng YY, Chou YH, Tarng DC, Chen TW. Association of anion gap with thyroid dysfunction and nodular goiter in CAPD patients. Perit Dial Int 2002;22:394-9.
  10. Jusufovic S, Hodzic E. Role of chronic hemodialysis in thyroid gland morphology disorders. Med Arh 2011;65:327-9. https://doi.org/10.5455/medarh.2011.65.327-329
  11. Murray SE, Sippel RS, Chen H. Incidence of concomitant hyperparathyroidism in patients with thyroid disease requiring surgery. J Surg Res 2012;178:264-7. https://doi.org/10.1016/j.jss.2012.03.008
  12. Burmeister LA, Sandberg M, Carty SE, Watson CG. Thyroid carcinoma found at parathyroidectomy: association with primary, secondary, and tertiary hyperparathyroidism. Cancer 1997;79:1611-6. https://doi.org/10.1002/(SICI)1097-0142(19970415)79:8<1611::AID-CNCR26>3.0.CO;2-#
  13. dell'Erba L, Baldari S, Borsato N, Bruno G, Calo-Gabrieli G, Carletto M, et al. Retrospective analysis of the association of nodular goiter with primary and secondary hyperparathyroidism. Eur J Endocrinol 2001;145:429-34.
  14. Arciero CA, Shiue ZS, Gates JD, Peoples GE, Dackiw AP, Tufano RP, et al. Preoperative thyroid ultrasound is indicated in patients undergoing parathyroidectomy for primary hyperparathyroidism. J Cancer 2012;3:1-6. https://doi.org/10.7150/jca.3.1
  15. Jung EJ, Yoon JH, Nam KH, Chang HS, Park CS. Thyroid nodules in patients with secondary hyperparathyroidism. Korean J Endocr Surg 2004;4:48-50. Korean. https://doi.org/10.16956/kjes.2004.4.1.48
  16. Taylor S. Calcium as a goitrogen. J Clin Endocrinol Metab 1954;14:1412-22. https://doi.org/10.1210/jcem-14-11-1412
  17. Lever EG, Refetoff S, Straus FH 2nd, Nguyen M, Kaplan EL. Coexisting thyroid and parathyroid disease--are they related? Surgery 1983;94:893-900.
  18. Karatoprak C, Kartal I, Kayatas K, Ozdemir A, Yolbas S, Meric K, et al. Does smoking affect thyroid gland enlargement and nodule formation in iodine-sufficient regions? Ann Endocrinol (Paris) 2012;73:542-5. https://doi.org/10.1016/j.ando.2012.09.008
  19. Knudsen N, Bulow I, Laurberg P, Perrild H, Ovesen L, Jorgensen T. Alcohol consumption is associated with reduced prevalence of goitre and solitary thyroid nodules. Clin Endocrinol (Oxf) 2001;55:41-6. https://doi.org/10.1046/j.1365-2265.2001.01325.x