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Exp Clin Endocrinol Diabetes 2018; 126(06): 349-356
DOI: 10.1055/s-0043-123184
Article
© Georg Thieme Verlag KG Stuttgart · New York

The Pituitary-Thyroid Axis and Prolactin Secretion in Hemodialysis Patients in Two Endemic Regions of Eastern Germany

Morphologic and laboratory abnormalities of the thyroid gland in CKD5D patients
Franz Maximilian Rasche
1   Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, University Leipzig, Leipzig, Germany
,
Ronny Rettig
2   Division of Nephrology, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
,
Thomas Frese
3   Institute of General Practice and Family Medicine, Medical Faculty, Martin Luther-University Halle-Wittenberg, Halle, Germany
,
Wilma Gertrud Rasche
4   Department of Head Medicine and Oral Health, Department of Ophthalmology, University Leipzig, Leipzig, Germany
,
Filip Barinka
5   Center for Geriatric Medicine at Bezirksklinikum Regensburg, Regensburg, Germany
,
Guenter Roesl
5   Center for Geriatric Medicine at Bezirksklinikum Regensburg, Regensburg, Germany
,
Frieder Keller
6   Medical Department I, Nephrology Devision, University Hospital, Ulm, Germany
,
Tom H. Lindner
1   Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, University Leipzig, Leipzig, Germany
,
Jochen G. Schneider
7   Translational & Experimental Medicine, Luxembourg Centre de Systems Biomedicine, Luxembourg
8   Department of Internal Medicine II, Saarland University, Homburg Saar, Germany
,
Joachim Beige
9   Division of Nephrology and KfH Renal Unit, Hospital St. Georg, Leipzig, Germany, Martin-Luther-University Halle/Wittenberg, Germany
,
Thomas Ebert   *
1   Department of Internal Medicine, Neurology, Dermatology, Clinic for Endocrinology, Diabetology and Nephrology, University Leipzig, Leipzig, Germany
,
Stephan Schiekofer   *
5   Center for Geriatric Medicine at Bezirksklinikum Regensburg, Regensburg, Germany
› Author Affiliations
Further Information

Publication History

received 27 June 2017
first decision 19 October 2017

accepted 15 November 2017

Publication Date:
23 February 2018 (online)

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Abstract

Introduction Endocrine disorders of the pituitary axes are frequent in patients with hemodialysis (CKD5D). The aim of this multicenter study (Leipzig (L), Quedlinburg and Blankenburg in the Harz region (Hz)) in CKD5D patients was to evaluate influences of CKD5D related factors, morphological and biochemical parameters, and serum iodine and prolactin concentrations on the pituitary-thyroid axis.

Patients and Methods 170 patients (L n=58; Hz n=112) were included in this prospective, non-interventional, cross-sectional study. Mann-Whitney-U-test and bivariate correlation analyses with Spearman-Rho test (r correlation coefficient) were used in statistical analysis.

Results TSH was higher in patients with prolactin concentrations>370 mIU/l (p=0.013), in patients with high flux membranes (p=0.0013) and in patients with longer dialysis vintage (p=0.04). Median iodine serum concentrations were slightly elevated in the Leipzig cohort (p=0.001) and correlated with fT4 (p<0.001, r=0.43) and albumin (p=0.001, r=0.245) but not with morphological signs. Albumin was correlated with fT3 (p<0.001, r=0.339) and fT4 (p<0.001, r=0.421). Prolactin was correlated with residual excretion rate (p=0.001, r=- 0.303) and thyroid volume (p=0.027, r=0.217).

Conclusions In the assessment of the thyroid status in CKD5D patients, the synopsis of the clinical and nutritional status, comorbidities, ultrasound of the thyroid gland and laboratory results is necessary for further intervention with hormone replacement. Standardized reference values of the pituitary-thyroid axis should be critically evaluated and are still lacking in CKD5D.

Key words

pituitary-thyroid axis - TSH - fT3 - fT4 - iodine serum concentration - prolactin - hemodialysis - goiter - nodule

* Both authors contributed equally


 

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