Inam ul Haq, M M Ahmad, M Adam, Abdul Majid, Shaheen Moin, Abdul Sattar.
Thyroid Dysfunction in Patients with Chronic Renal Failure (CRF) on Hemodialysis.
J Rawal Med Coll Jan ;4(1-2):20-3.

The present study was carried out to observe the effect of chronic renal failure (CRF) and hemodialysis on thyroid hormones. Serum levels of free thyroxine (FT4), total tri iodothyronine (TT3) and thyroid stimulating hormone (TSII) were measured by chemiluminescent enzyme immunoassay. The patients were divided into three groups. Group I included healthy controls (n=20), Group II included cases of CRF undergoing hemodialysis (n=30) and in group III, patients of CRF being managed conservatively (n=10). A comparison of FT4 between group I and group II showed significantly lower levels of FT4 in group Il (P < 0.001). Similar results were observed while comparing FT4 levels in group I and group III (P < 0.001). Comparison of TT3 between group I and II and then between group I and III did not show significant variation (P>0.05). However TSH levels were significantly lower in group II while comparing with group I (P < 0.05). A comparison of TSH levels between group I and group III showed a significantly lower effect in group III (P < 0.01). The study suggests a significant lowering of FT4 levels both in conservative and hemodialysis groups. However, the levels of TT3 remain unchanged. TSH levels were found to lower significantly both in group II and group III. Hence it was concluded that the patients of CRF undergoing hemodialysis or being managed conservatively were clinically euthyroid. Hence these patients were categorized as the cases of "Euthyroid Sick Syndrome" which differ from true hypothyroidism. Furthermore, a tendency of TSH towards lower limits of normal suggests either an impaired pituitary response to low plasma thyroid hormone levels or may be associated with raised plasma rT3 levels.

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