Thyroid Dysfunction in Children with Idiopathic Nephrotic Syndrome Attending a Paediatric Hospital in Qazvin, Iran

Abstract

Objectives: Nephrotic syndrome is a glomerular disease characterised by a loss of albumin and high-molecular-weight proteins such as thyroxine-binding globulin and thyroid hormones, potentially resulting in subclinical or even overt hypothyroidism. This study aimed to compare thyroid hormone levels between nephrotic children and healthy controls as well as between nephrotic children in the active phase of the disease and those in remission.

Methods: This case-control study was conducted between March 2016 and 2018 at a paediatric hospital in Qazvin, Iran. A total of 73 nephrotic children comprised the case group-including 49 with active disease and 24 in remission-while the control group included 74 healthy children. Thyroid function was assessed according to levels of thyroid-stimulating hormone (TSH), free triiodothyronine (T3), free thyroxine (T4), total T4, total T3 and anti-thyroid peroxidase.

Results: All of the controls had normal total T4 levels. Elevated TSH levels were more frequent in nephrotic children compared to controls (34.2% versus 10.8%; P = 0.001). A significantly lower number of patients with active disease were euthyroid compared to those in remission (51% versus 95.8%; P = 0.001). Moreover, 7 (9.5%) of patients in the active and no patient in remission phase had abnormal total T4 levels (P <0.001), while 14.3% and 0% had highly elevated TSH levels (P = 0.002).

Conclusion: Due to the prevalence of subclinical and even overt hypothyroidism, thyroid screening tests may be required for nephrotic children. However, further research is needed to confirm these findings.

Keywords: Albuminuria; Children; Hypothyroidism; Iran; Nephrotic Syndrome; Proteinuria.