만성 신질환에서 갑상선기능 저하증의 빈도

Prevalence of Hypothyroidism in Patients with Chronic Kidney Disease

  • 김혜영 (충북대학교 의과대학 내과학교실)
  • Kim, Hye-Young (Department of Internal Medicine, Chungbuk National University College of Medicine)
  • 발행 : 2011.09.01

초록

Chronic kidney disease (CKD) affects both hypothalamus-pituitary-thyroid axis and peripheral metabolism of thyroid hormones. CKD is associated with a higher prevalence of both overt and subclinical primary hypothyroidism. Recent studies have shown that the prevalence of primary hypothyroidism, mainly in the subclinical form, increases as GFR decreases. In this issue of the journal, Lee et al. reported that the prevalence of overt hypothyroidism increased from 0.5% at an estimated GFR > 90 mL/min per $1.73\;m^{2}$ to 6.3% at ESRD requiring dialysis, and it is independently associated with progressively lower estimated GFR. However, additional large, community based studies will be required to determine the prevalence of primary hypothyroidism at different levels of kidney function in Korean population. Further investigations are need to elucidate the potential causal mechanism linking hypothyroidism and CKD, adverse effects of hypothyroidism on cardiovascular risk associated with CKD, and clinical value of routine monitoring for hypothyroidism among patients with CKD.

키워드

참고문헌

  1. Lo JC, Chertow GM, Go AS, Hsu CY. Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease. Kidney Int 2005;67:1047-1052. https://doi.org/10.1111/j.1523-1755.2005.00169.x
  2. Song IS, Oh SJ, Jeong HS, Lee JH. The effects of hemodialysis and kidney transplantation on the thyroid function in patients with chronic renal failure. Korean J Med 1996;51:79-87.
  3. Lee HH, Kim DJ, Kim JA, et al. Changes of the thyroid function in continuous ambulatory peritoneal dialysis patients. Korean J Nephrol 2003;22:96-101.
  4. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-499. https://doi.org/10.1210/jc.87.2.489
  5. Tunbridge WM, Evered DC, Hall R, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf) 1977;7:481-493. https://doi.org/10.1111/j.1365-2265.1977.tb01340.x
  6. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-499. https://doi.org/10.1210/jc.87.2.489
  7. Chonchol M, Lippi G, Salvagno G, Zoppini G, Muggeo M, Targher G. Prevalence of subclinical hypothyroidism in patients with chronic kidney disease. Clin J Am Soc Nephrol 2008;3:1296-1300. https://doi.org/10.2215/CJN.00800208
  8. Zoccali C, Tripepi G, Cutrupi S, Pizzini P, Mallamaci F. Low triiodothyronine: a new facet of inflammation in end-stage renal disease. J Am Soc Nephrol 2005;16:2789-2795. https://doi.org/10.1681/ASN.2005040356
  9. Zoccali C, Benedetto F, Mallamaci F, et al. Low triiodothyronine and cardiomyopathy in patients with end-stage renal disease. J Hypertens 2006;24:2039-2046. https://doi.org/10.1097/01.hjh.0000244954.62362.8f
  10. Zoccali C, Mallamaci F, Tripepi G, Cutrupi S, Pizzini P. Low triiodothyronine and survival in end-stage renal disease. Kidney Int 2006;70:523-528.
  11. Lee DH, Jeon YD, Lee SH, Mun GS, Na SS, Cha HH. Prevalence of hypothyroidism in patient with chronic kidney disease. Korean J Med 2011;81:334-339.