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Review
. 2019 Nov;28(6):621-630.
doi: 10.1097/MNH.0000000000000542.

Thyroid disease in end-stage renal disease

Connie M Rhee  1
Affiliations
Review

Thyroid disease in end-stage renal disease

Connie M Rhee. Curr Opin Nephrol Hypertens. 2019 Nov.

Abstract

Purpose of review: Hypothyroidism is a highly prevalent endocrine disorder in the end-stage renal disease (ESRD) population, yet many cases may remain latent and undiagnosed.

Recent findings: Epidemiologic data show that there is a nearly five-fold higher prevalence of hypothyroidism in advanced chronic kidney disease (CKD) patients vs. those without CKD. Given that the metabolism, degradation, and excretion of thyroid hormone and its metabolites, as well as the regulation of the hypothalamic-pituitary-thyroid axis may be altered in ESRD, certain considerations should be made when interpreting thyroid functional tests in these patients. Growing evidence shows that hypothyroidism and other thyroid functional test derangements are associated with higher risk of cardiovascular disease, worse patient-centered outcomes, and survival in the advanced CKD population, including those with ESRD. Although limited data examining treatment of hypothyroidism suggests benefit, further studies of the efficacy and safety of thyroid hormone supplementation, including clinical trials and rigorous longitudinal observational studies are needed to inform the management of thyroid dysfunction in CKD.

Summary: Given the high burden of hypothyroidism in ESRD patients, and potential ill effects on their cardiovascular health, patient-centered outcomes, and survival, further research is needed to inform the optimal management of thyroid dysfunction in this population.

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Conflict of interest statement

Conflicts of Interest:

None.

Figures

Figure 1.
Figure 1.
Clinical manifestations of hypothyroidism.
Figure 2.
Figure 2.
Pathways between hypothyroidism and kidney disease.
Figure 3.
Figure 3.
Pathways between hypothyroidism and cardiovascular disease.
See this image and copyright information in PMC

References

    1. Rhee CM. Abnormalities of Thyroid Function in Chronic Dialysis Patients. In Nissenson Handbook of Dialysis Therapy, 5th edition, edited by Nissenson A Philadelphia: Saunders Elsevier, 2016.
    1. Kalim S, Rhee CM. Thyroid Status in Chronic Renal Failure – A Non-Thyroidal Illness Syndrome. In Textbook of Nephro-Endocrinology: Hormones in Kidney Disease, 2nd edition, edited by Singh A, Williams G. New York: Elsevier, 2017.
    1. Rhee CM, Brent GA, Kalantar-Zadeh K. Thyroid Dysfunction and Outcomes in Kidney Disease. Diagnosis and Treatment of Endocrine Disorders in Kidney Disease, 1st edition, edited by Rhee CM, Brent GA, Kalantar-Zadeh K. New York: Springer Science, 2019.
    1. Rhee CM. The interaction between thyroid and kidney disease: an overview of the evidence. Curr Opin Endocrinol Diabetes Obes 2016;23(5):407–15. - PMC - PubMed
    1. Rhee CM, Brent GA, Kovesdy CP, et al. Thyroid functional disease: an under-recognized cardiovascular risk factor in kidney disease patients. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2015;30(5):724–37. - PMC - PubMed

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