1983 Volume 25 Issue 8 Pages 983-991
Metabolic state and pituitary-thyroid function were investigated in patients with endstage renal failure in order to clarify the pathomechanism of the thyroid disturbances. Patients, who were all free from thyroid diseases, were divided into three groups; the non-dialyzed, azotemic patients with high serum creatinine level (1.5-8mg/dl) (group I), the patients prior to dialysis therapy with uremic symptoms (group II), and the patients receiving hemodaalysis for more than six months (group III). 211 patients in group III showed weakness (75.4%), cold intolerance (63.6%), memory impairment (60.6%), constipation (55%), dry skin (34%), and others. These symptoms are very similar to hypothyroidism. Patients in group I demonstrated lower normal value of total thyroxine (TT4), low value of total triiodothyronine (TT3) (P<0.001), normal values of free T4(FT4) and reverse T3 (rT3), and slightly high basal value of thyrotropin (TSH) (P<0.025). Patients in group II revealed much lower value of TT4, TT3, FT4(P<0.001) and high basal level of TSH (P<0.005). Patients in group III disclosed low values of TT4, TT3, FT3 (P<0.001), rT3 (P<0.005) and normal level of TSH. Moreover, there were significant reductions in TT3/TT4 ratio levels in all groups compaired with normal controls. The pituitary secretion of TSH after thyrotropin-releasing hormone (TRH) injection was very poor in groups I and II. Although group III patients showed the moderate recovery of TSH secretion reserve, the maximum increment of serum TSH was insufficient in comparison with normal controls. Hemodialysis patients showed significantly low level of the thyroidal 131I-uptake after oral and intravenous radioiodide administration. Basal metabolic rate was -19.4±8.4% and the contraction phase of the Achilles tendon reflex was significantly elongated in these patients. These data indicate that patients with chronic renal failure have the abnormalities of the pituitary-thyroid axis and appear to be in hypometabolic state.
