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Erişkin Nefrotik Sendromlu Hastalarda Düşük T3 Sendromu

Low T3 Syndrome in Adult Patients with Nephrotic Syndrome

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2014
DOI: 
10.5262/tndt.2014.1002.10

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
OBJEC TIVE: The aim of this study is to evaluate the frequency of thyroid dysfunction in adult patients with nephrotic syndrome and to investigate the relation between nephrotic syndrome and low triiodothyronine (T3) syndrome. MATER IAL and METHODS: Thirty three adult patients with nephrotic syndrome and 20 healthy controls were included in the study. Serum thyroid-stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) were measured by chemiluminescent immunoassay. Proteinuria was measured in a 24-hour urine collection. Estimated Glomerular Filtration Rate (eGFR) was calculated by the Modification of Diet in Renal Disease (MDRD) equation. RE SULTS: The mean age of the patients was 49±17 years. The mean levels for the parameters measured were as follows: serum albumin, 22±5 (g/L); urinary protein excretion in 24 hour collections, 7.8±4.5 (g/day), serum creatinine 1.32±0.66 (mg/dL) ; serum TSH, 3.2±3.1 (mIU/mL).; fT3, 2.5±0.6 (pg/mL), and fT4, 1.0±0.30 (ng/dL). In nephrotic syndrome patients, the mean serum TSH level was significantly higher whereas mean fT3 level was significantly lower when compared to the levels in the control group. Serum fT3 level correlated positively with serum albumin (r:0.56, p:0.01) and fT4 (r:0.51, p:0.03) and negatively with total cholesterol (r:-0.39, p:0.03). Seven (21%) patients were hypothyroid, 3 (9%) were hyperthyroid, and 11 (33%) had low T3 syndrome. CONCL USION: Thyroid dysfunction, low T3 syndrome in particular, is frequent in adult patients with nephrotic syndrome. The free T3 level correlates with the severity of nephrotic syndrome. Further studies are necessary regarding the clinical importance of low T3 syndrome.
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Abstract (Original Language): 
AMAÇ: Bu çalışmanın amacı, erişkin nefrotik sendromlu olgularda tiroid disfonksiyonu sıklığını değerlendirmek, ve düşük triiodotironin (T3) sendromu ve nefrotik sendrom arasındaki ilişkiyi incelemektedir. GERE Ç ve YÖNTEMLER : Tiroid fonksiyon parametreleri olan, 33 erişkin nefrotik sendromlu olgu ve 20 sağlıklı kontrol çalışmaya alındı. Serum tiroid sitimüle edici hormon (TSH), serbest tiroksin (fT4) ve serbest T3 (fT3) düzeyleri Kemilüminesans ile immünoassay yöntemi kullanılarak incelendi. Glomerüler filtrasyon hızı (eGFH), Renal Hastalıkta Diyet Modifikasyonu (MDRD) formülü kullanılarak hesaplandı. Proteinüri 24 saatlik idrarda ölçüldü. BULGULAR: Hastaların yaş ortalamaları 49±17 yıldı. Ortalama serum albumine 22±5 (g/L), 24 saatlik idrarda protein 7,8±4,5 (g/gün) ve serum kreatinin 1,32±0,66 (mg/dL)’di. Hastaların TSH ortalaması 3,2±3,1(mIU/mL), serbest T3 ortalaması 2,5±0,6 (pg/mL) ve serbest T4 ortalaması 1,0±0,30 (ng/dL)’dı. Nefrotik sendromlu hastalar kontrol grubuyla kıyaslandığında ortalama TSH düzeyleri daha yüksek, serbest T3 düzeyleri ise daha düşüktü. Nefrotik sendromlu hastalarda serbest T3 düzeyi, serum albumin (r:0,56, p:0,01), ve serbest T4 (r:0,51,p:0,03) ile pozitif, total kolesterol (r: -0,39, p:0,04) ile ise negatif korelasyon göstermekteydi. Hastaların 7 (%21) tanesinde hipotroidi, 3’ünde (%9) hipertroidi ve 11 ‘inde (%33) ise düşük T3 sendromu vardı.SONUÇ: Erişkin nefrotik sendromlu olgularda düşük T3 sendromu başta olmak üzere tiroid disfonksiyonu oldukça fazla görülmektedir. Serbest T3 düzeyi ile nefrotik sendromun ciddiyeti arasında korelasyon bulunmuştur. Düşük T3 sendromunun klinik önemine yönelik ileri incelemeye ihtiyaç vardır.
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