Evaluation of renal function in subclinical hypothyroidism

Abstract

INTRODUCTION: Patients with subclinical hypothyroidism (SCH) have a few or no symptoms or signs of thyroid dysfunction and thus by its very nature, SCH is a laboratory diagnosis. Serum creatinine is elevated and glomerular filtration rate (GFR) values are reversibly reduced in overt hypothyroid patients. We hypothesize that SCH also may be associated with low GFR.

AIMS AND OBJECTIVES: The objective of this study was (1) to know the effect of SCH on kidney function, (2) to find the correlation between the renal function parameter creatinine, estimated GFR (eGFR), and thyroid-stimulating hormone (TSH), and (3) to know if creatinine values can be predicted by TSH values in SCH cases.

MATERIALS AND METHODS: This is a hospital-based cross-sectional study for 1 year. A total of 608 subjects of either sex were included in the study and were divided into 3 groups: (1) SCH, (2) overt hypothyroidism (OHT), and (3) euthyroidism (ET). TSH, free triiodothyronine, free thyroxine, and serum creatinine were estimated and eGFR was calculated using modification of diet in renal disease study equation and the chronic kidney disease epidemiology collaboration equations.

RESULTS: Serum creatinine levels were higher and eGFR was lower significantly in the subclinical hypothyroid group when compared to the control ET group (P < 0.001). The overtly hypothyroid group had significantly higher levels of serum creatinine and lower eGFR when compared to both the groups (P < 0.001). Significant correlation between TSH, creatinine, and eGFR was found in OHT group only. Linear regression analysis showed the regression in creatinine upon TSH is attributable to 44.5% among OHT group, 48.2% in SCH group.

CONCLUSION: It can be concluded that the SCH group behaves biochemically similar to OHT group and changes in serum creatinine reflect tissue hypothyroidism in SCH cases.

Key words

Creatinine - estimated glomerular filtration rate - renal dysfunction - subclinical hypothyroidism - thyroid-stimulating hormone - tissue hypothyroidism

Publication History

Received: 10 April 2017

Accepted: 28 July 2017

Article published online:
19 February 2020

• 1 Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH, et al. Subclinical thyroid disease: Scientific review and guidelines for diagnosis and management. JAMA 2004;291:228-38.
• 2 Deshmukh V, Behl A, Iyer V, Joshi H, Dholye JP, Varthakavi PK, et al. Prevalence, clinical and biochemical profile of subclinical hypothyroidism in normal population in Mumbai. Indian J Endocrinol Metab 2013;17:454-9.
• 3 Kimmel M, Braun N, Alscher MD. Influence of thyroid function on different kidney function tests. Kidney Blood Press Res 2012;35:9-17.
• 4 Saini V, Yadav A, Arora MK, Arora S, Singh R, Bhattacharjee J, et al. Correlation of creatinine with TSH levels in overt hypothyroidism – A requirement for monitoring of renal function in hypothyroid patients? Clin Biochem 2012;45:212-4.
• 5 Basu G, Mohapatra A. Interactions between thyroid disorders and kidney disease. Indian J Endocrinol Metab 2012;16:204-13.
• 6 Iglesias P, Díez JJ. Thyroid dysfunction and kidney disease. Eur J Endocrinol 2009;160:503-15.
• 7 Claus T, Elitok S, Schmitt R, Luft FC, Kettritz R. Thyroid function and glomerular filtration – A potential for grave errors. Nephrol Dial Transplant 2005;20:1002-3.
• 8 Iglesias P, Bajo MA, Selgas R, Díez JJ. Thyroid dysfunction and kidney disease: An update. Rev Endocr Metab Disord 2017;18:131-44.
• 9 Mariani LH, Berns JS. The renal manifestations of thyroid disease. J Am Soc Nephrol 2012;23:22-6.
• 10 Levey AS, Coresh J, Greene T, Marsh J, Stevens LA, Kusek JW, et al. Expressing the modification of diet in renal disease study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007;53:766-72.
• 11 Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3^rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150:604-12.
• 12 Asvold BO, Bjøro T, Vatten LJ. Association of thyroid function with estimated glomerular filtration rate in a population-based study: The HUNT study. Eur J Endocrinol 2011;164:101-5.
• 13 Woodward A, McCann S, Al-Jubouri M. The relationship between estimated glomerular filtration rate and thyroid function: An observational study. Ann Clin Biochem 2008;45:515-7.
• 14 den Hollander JG, Wulkan RW, Mantel MJ, Berghout A. Correlation between severity of thyroid dysfunction and renal function. Clin Endocrinol (Oxf) 2005;62:423-7.
• 15 McDermott MT, Ridgway EC. Subclinical hypothyroidism is mild thyroid failure and should be treated. J Clin Endocrinol Metab 2001;86:4585-90.
• 16 Lu Y, Guo H, Liu D, Zhao Z. Preservation of renal function by thyroid hormone replacement in elderly persons with subclinical hypothyroidism. Arch Med Sci 2016;12:772-7.
• 17 Wilkins L, Fleischmann W. Effects of thyroid on creatine metabolism with a discussion of the mechanism of storage and excretion of creatine bodies. J Clin Invest 1946;25:360-77.
• 18 Schmitt R, Klussmann E, Kahl T, Ellison DH, Bachmann S. Renal expression of sodium transporters and aquaporin-2 in hypothyroid rats. Am J Physiol Renal Physiol 2003;284:F1097-104.
• 19 Levey AS, Inker LA, Coresh J. GFR estimation: From physiology to public health. Am J Kidney Dis 2014;63:820-34.
• 20 Lai Y, Wang J, Jiang F, Wang B, Chen Y, Li M, et al. The relationship between serum thyrotropin and components of metabolic syndrome. Endocr J 2011;58:23-30.
• 21 Rotondi M, Magri F, Chiovato L. Risk of coronary heart disease and mortality for adults with subclinical hypothyroidism. JAMA 2010;304:2481.
• 22 Tsuda A, Inaba M, Ichii M, Ochi A, Ohno Y, Nakatani S, et al. Relationship between serum TSH levels and intrarenal hemodynamic parameters in euthyroid subjects. Eur J Endocrinol 2013;169:45-50.