Abstract
The thyroid function of seven children with untreated nephrotic syndrome who had a normal serum creatinine concentration was compared with that of the same patients in remission and age-matched controls. There was a significant decrease in serum thyroxine (T4), tri-iodothyronine (T3) and thyroid-binding globulin (TBG) concentrations in untreated nephrotic children compared with the same patients in remission and age-matched controls. Most values for serum free T4, free T3 and thyroid-stimulating hormone (TSH) in the patients with nephrosis were within the normal range. However, the mean serum free T4 and free T3 concentrations were significantly (P<0.05) lower in the untreated patients than in the same patients in remission, and the mean serum TSH concentrations were significantly (P<0.05) higher in the untreated patients than in the same patients in remission. There were massive urinary losses of T4, T3, TBG. free T4 and free T3 in the untreated nephrotic children compared with the same patients in remission and age-matched controls. The daily urinary protein excretion showed a positive correlation with the urinary T4, T3, free T4, free T3 and TBG excretion. Furthermore, the urinary protein excretion showed a negative correlation with the serum T4, T3, free T4, free T3 and TBG levels. There was a negative correlation between serum albumin and serum TSH. These findings provide evidence of mild hypothyroidism in children with untreated nephrotic syndrome, partly because of losses of T4, T3, free T4, free T3 and TBG into the urine.
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Gavin LA, McMahon FA, Castle JN, Cavafieri RR (1978) Alterations in serum thyroid hormones and thyroxine-binding globulin in patients with nephrosis. J Clin Endocrinol Metab 46: 125–130
Adlkofer F, Hain H, Meinhold H, Kraft D, Ramsden D, Herrmann J, Heller WD (1983) Tyhroid function in patients with proteinuria and normal or increased serum creatinine concentration. Acta Endocrinol (Copenh) 102: 367–376
Afrasiabi MA, Vaziri ND, Gwinup G, Mays DM, Barton CH, Ness RL, Valenta LJ (1979) Thyroid function studies in the nephrotic syndrome. Ann Intern Med 90: 335–338
DeLuca F, Gamelli M, Pandullo E, Barberio G, Benvenga S, Trimarchi F (1983) Changes in thyroid function tests in infantile nephrotic syndrome. Horm Metabo Res 15: 258–259
Liappis N, Rao GS (1985) Verhalten der Konzentration von freiem Trijodthyronin, Trijodthyronin, freiem Thyroxin, Thyroxin, Thyreotropin und thyroxinbindendem Globulin im Serum von Kindern mit nephrotischem Syndrom. Klin Pediatr 197: 423–426
Etling N, Fouque F (1982) Effect of prednisone on serum and urinary thyroid hormone levels in children during the nephrotic syndrome. Helv Paediatr Acta 37: 257–265
McLean RH, Kennedy TL, Rosoulpour M, Ratzan SK, Siegel NJ, Kauschansky A, Genel M (1982) Hypothyroidism in the congenital nephrotic syndrome. J Pediatr 101: 72–75
Warydy BA, Howard CP, Hellerstein S, Alon U, Grune JA (1993) Congenital nephrosis in association with hypothyroidism and hypoadrenocortism. Pediatr Nephrol 7: 79–80
Kano K, Hagane M, Ito S, Ichimura T (1993) Thyroid therapy for a boy with nephrotic syndrome. J Jpn Pediatr Soc 97: 1298
Nicoloff JT, Fisher DA, Appleman MD (1970) The role of glucocorticoids in the regulation of thyroid function in man. J Clin Invest 49: 1922–1929
Larsen PR (1972) Salicylate-induced increases in free triiodothyronine in human serum: evidence of inhibition of triiodothyronine binding to thyroxine-binding globulin and thyroxine-binding prealbumin. J Clin Invest 51: 1125–1134
Schwartz HL, Schadlow AR, Faierman D, Surks MI, Oppenheimer JH (1973) Heparin administration appears to decrease cellular binding of thyroxine. J Clin Endocrinol Metab 36: 598–600
Csako G, Zweig MH, Glickman J, Ruddel M, Kestner J (1989) Direct and indirect techniques for free thyroxin compared in patients with nonthyroidal illness. II. Effect of prealbumin, albumin, and thyroxin-binding globulin. Clin Chem 35: 1655–1662
Kano K, Ito S, Hagane M, Ichimura T (1992) Difference between the two determinations of FT3 and FT4 in childhood renal diseases (in Japanese). J Med Pharmaceut Sci 27: 979–984
Spain R, Gasser F, Schlienger JL (1991) Free triiodothyronine concentrations as measured by two one-step radioimmunoassays in non-thyroidal illness. Clin Chem 37: 115–116
Feinstein EI, Kaptein EM, Nicoloff JT, Massry SG (1982) Thyroid function in patients with nephrotic syndrome and normal renal function. Am J Nephrol 2: 70–76
Fonseca V, Thomas M, Katrak A, Sweny P, Moorhead JF (1991) Can urinary thyroid hormone loss cause hypothyroidism? Lancet 338: 475–476
Liewendahl K, Tikanoja S, Helenius T, Välimäki M (1984) Discrepancies between serum free triiodothyronine and free thyroxin as measured by equilibrium dialysis and analog radioimmunoassay in nonthyroidal illnesses. Clin Chem 30: 760–762
Meaney MJ, Aitken DH, Sapolsky RM (1987) Thyroid hormones influence the development of hippocampal glucocorticoid receptors in the rat: a mechanism for the effects of postnatal handling on the development of the adrenocortical stress response. Neuroendocrinology 45: 278–283
Naito K, Isohashi F, Tsukanaka K, Horiuchi M, Okamoto K, Matsunaga T, Sakamoto Y (1985) Effect of d-and l-thyroxine on the glucocorticoid binding capacity of adult rat liver. Biochem Biophys Res Commun 129: 447–452
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Ito, S., Kano, K., Ando, T. et al. Thyroid function in children with nephrotic syndrome. Pediatr Nephrol 8, 412–415 (1994). https://doi.org/10.1007/BF00856516
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DOI: https://doi.org/10.1007/BF00856516