laxmi 5th sem

School of Health and Allied Sciences

Pokhara University

Prevalence and Clinical Characteristics of

Hypothyroidism in a Population Undergoing

Maintenance Hemodialysis in Nepal

Laxmi Narayan NeupaneFifth Semester, B.Pharm.

School of Health and Allied SciencesPokhara University, Lekhnath-12, Kaski , NEPAL

Saturday, December

10, 2016Pharmaceutical Seminar-4 1


Pokhara University

INTRODUCTION

Thyroid dysfunction affects renal physiology and

development, where as kidney disease could result in

thyroid dysfunction.

End stage renal disease (ESRD) alter the

hypothalamic-pituitary-thyroid hormone axis as well

as peripheral thyroid hormone metabolism.

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10, 2016

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Cont…

In ESRD: Increased prevalence of goiter and thyroid

volume, as well as increased primary hypothyroidism

compared with the general population.

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Cont...

What is Hemodialysis ?

ESRD cause the kidneys to lose their ability to filter

and remove waste and extra fluid from the body.

Hemodialysis is a process that uses a man-made

membrane (dialyzer) to:

Remove wastes, such as urea from the blood.

Restore the proper balance of electrolytes in the

blood.

Eliminate extra fluid from the body.

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Cont…

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METHODS

Hemodialysis patients for maintenance treatment at

the Hemodialysis Unit in Gandaki Medical College

Teaching Hospital (1st January 2011 to 31st Dec.

2011) Pokhara ,Nepal

A total of 64 subjects were enrolled.

Inclusion criteria: age above 18 years

Exclusion criteria: under treatment for thyroid

disorders.

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Laboratory Measurement

Blood for laboratory analysis was collected on the

day of hemodialysis.

Thyroid function tests

TSH, free T4 and T3 serum levels, were performed

using ELISA method.

The normal free range for TSH, T4 and T3:

0.39-6.16 μIU/ml , 0.8-2.0 ng/dl , 1.4-4.2 pg/ml

respectively.

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Statistical Analysis

Statistical calculation was done using SPSS 14.0

software. All continuous variables are expressed as

mean ± SD and proportion are expressed as a

number (%). For comparing portion we have used

Chi-square or Fisher’s exact test as appropriate.

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RESULTSGroup 1

(TSH ≤ 0.388 μIU/ml)

Group 2

(TSH 0.39-6.16 μIU/ml)

Group 3

(TSH ≥ 6.17 μIU/ml)

n

2 (3.13%) 45 (70.3%) 17 (26.6%)

Female/Male ratio 1/1 12/33 3/14

Mean age (years) 45 ± 14.1 48.7 ± 17.9 42.1 ± 13.5

Mean TSH level (μIU/ml) 0.16 ± 0.19 2.92 ± 1.59 11.32 ± 7.26

Mean fT4 level (ng/dl) 1.15 ± 0.07 1.18 ± 0.39 0.73 ± 0.30

Mean fT3 level (pg/ml) 2.5 ± 1.13 2.60 ± 0.67 1.54 ± 0.74

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Cont…

Clinical Sign and Symptoms Associated with Hypothyroidism

All symptoms were found present in both groups, there are

difference in prevalence.

Cold intolerance

Constipation

Dry skin

Tingling sensation

Muscle pain or weakness

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DISCUSSION

Found high prevalence of primary hypothyroidism in a dialysis

patient population.

(TSH > 6 μIU/ml ) is 7.5% in women and 2.8% in men, and is

reported to be 5% in multiple population.

The analysis of the third national survey in the US revealed, that

among patient with chronic kidney disease, the prevalence of

hypothyroidism increase with lower levels of glomerulus filtration

rate (GFR), in subject with GFR <30ml/min/1.73m 2 the

prevalence was 23.1%

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Pokhara University

Cont…

Multiple factors leading to thyroid abnormalities in patients with

CKD: reduced deiodinase activity, tissue and circulating level of

the active form of T3 low in kidney failure.

Inorganic iodide generated by residual deiodinase activity

accumulates in stage 4 and 5 CKD.

Accumulation of toxic uremic solutes alter the hypothalamic

pituitary gland: TSH is subnormal.

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Cont…

Undiagnosed and untreated hypothyroidism is poisoning

danger in many ways:

First: ESRD patient have a well recognized increase risk of

cardiovascular disease (10 fold higher mortality rates).

Second: hypothyroidism impairs myocardial function. In CKD

patients cardiac function can be already challenged by fluid

overload, overt hypertension anemia etc.

Third: neurobehavioral and neuromuscular dysfunction.

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Pokhara University

Saturday, December

10, 2016



Pokhara University

CONCLUSION

In present study we have found high prevalence of

subclinical and clinical hypothyroidism among

hemodialysis patients, 26.6% of the study subjects

had TSH levels above the reference range.

It was also shown that cold intolerance, constipation,

dry skin and the presence of tingling sensation were

much more common among patients with high TSH

levels.

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Pokhara University

Cont…

The diagnosis of hypothyroidism can be easily

missed in the ESRD population, because the

symptoms of CKD and hypothyroidism overlap.

Timely diagnosis and treatment of hypothyroidism

may prevent deterioration of patient condition and

prolong survival.

Knowing the high prevalence, clinicians should pay

attention on this factor and screen routinely for

thyroid function disorders in the CKD population.

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REFERENCE

Paudel K (2014) Prevalence and clinical

characteristics of hypothyroidism in a population

undergoing maintenance hemodialysis. Journal of

clinical and diagnostic research; 8(4), MC01-MC04.

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laxmi 5th sem

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