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School of Health and Allied Sciences
Pokhara University
Prevalence and Clinical Characteristics of
Hypothyroidism in a Population Undergoing
Maintenance Hemodialysis in Nepal
Laxmi Narayan NeupaneFifth Semester, B.Pharm.
School of Health and Allied SciencesPokhara University, Lekhnath-12, Kaski , NEPAL
Saturday, December
10, 2016Pharmaceutical Seminar-4 1
School of Health and Allied Sciences
Pokhara University
INTRODUCTION
Thyroid dysfunction affects renal physiology and
development, where as kidney disease could result in
thyroid dysfunction.
End stage renal disease (ESRD) alter the
hypothalamic-pituitary-thyroid hormone axis as well
as peripheral thyroid hormone metabolism.
Saturday, December
10, 2016
Pharmaceutical Seminar-4 2
School of Health and Allied Sciences
Pokhara University
Cont…
In ESRD: Increased prevalence of goiter and thyroid
volume, as well as increased primary hypothyroidism
compared with the general population.
Saturday, December
10, 2016
Pharmaceutical Seminar-4 3
School of Health and Allied Sciences
Pokhara University
Cont...
What is Hemodialysis ?
ESRD cause the kidneys to lose their ability to filter
and remove waste and extra fluid from the body.
Hemodialysis is a process that uses a man-made
membrane (dialyzer) to:
Remove wastes, such as urea from the blood.
Restore the proper balance of electrolytes in the
blood.
Eliminate extra fluid from the body.
Saturday, December
10, 2016
Pharmaceutical Seminar-4 4
School of Health and Allied Sciences
Pokhara University
Cont…
Saturday, December
10, 2016
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School of Health and Allied Sciences
Pokhara University
METHODS
Hemodialysis patients for maintenance treatment at
the Hemodialysis Unit in Gandaki Medical College
Teaching Hospital (1st January 2011 to 31st Dec.
2011) Pokhara ,Nepal
A total of 64 subjects were enrolled.
Inclusion criteria: age above 18 years
Exclusion criteria: under treatment for thyroid
disorders.
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10, 2016
Pharmaceutical Seminar-4 6
School of Health and Allied Sciences
Pokhara University
Cont...
Laboratory Measurement
Blood for laboratory analysis was collected on the
day of hemodialysis.
Thyroid function tests
TSH, free T4 and T3 serum levels, were performed
using ELISA method.
The normal free range for TSH, T4 and T3:
0.39-6.16 μIU/ml , 0.8-2.0 ng/dl , 1.4-4.2 pg/ml
respectively.
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10, 2016
Pharmaceutical Seminar-4 7
School of Health and Allied Sciences
Pokhara University
Cont…
Statistical Analysis
Statistical calculation was done using SPSS 14.0
software. All continuous variables are expressed as
mean ± SD and proportion are expressed as a
number (%). For comparing portion we have used
Chi-square or Fisher’s exact test as appropriate.
Saturday, December
10, 2016
Pharmaceutical Seminar-4 8
School of Health and Allied Sciences
Pokhara University
RESULTSGroup 1
(TSH ≤ 0.388 μIU/ml)
Group 2
(TSH 0.39-6.16 μIU/ml)
Group 3
(TSH ≥ 6.17 μIU/ml)
n
2 (3.13%) 45 (70.3%) 17 (26.6%)
Female/Male ratio 1/1 12/33 3/14
Mean age (years) 45 ± 14.1 48.7 ± 17.9 42.1 ± 13.5
Mean TSH level (μIU/ml) 0.16 ± 0.19 2.92 ± 1.59 11.32 ± 7.26
Mean fT4 level (ng/dl) 1.15 ± 0.07 1.18 ± 0.39 0.73 ± 0.30
Mean fT3 level (pg/ml) 2.5 ± 1.13 2.60 ± 0.67 1.54 ± 0.74
Saturday, December
10, 2016
Pharmaceutical Seminar-4 9
School of Health and Allied Sciences
Pokhara University
Cont…
Clinical Sign and Symptoms Associated with Hypothyroidism
All symptoms were found present in both groups, there are
difference in prevalence.
Cold intolerance
Constipation
Dry skin
Tingling sensation
Muscle pain or weakness
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10, 2016
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School of Health and Allied Sciences
Pokhara University
DISCUSSION
Found high prevalence of primary hypothyroidism in a dialysis
patient population.
(TSH > 6 μIU/ml ) is 7.5% in women and 2.8% in men, and is
reported to be 5% in multiple population.
The analysis of the third national survey in the US revealed, that
among patient with chronic kidney disease, the prevalence of
hypothyroidism increase with lower levels of glomerulus filtration
rate (GFR), in subject with GFR <30ml/min/1.73m 2 the
prevalence was 23.1%
Saturday, December
10, 2016
Pharmaceutical Seminar-4 11
School of Health and Allied Sciences
Pokhara University
Cont…
Multiple factors leading to thyroid abnormalities in patients with
CKD: reduced deiodinase activity, tissue and circulating level of
the active form of T3 low in kidney failure.
Inorganic iodide generated by residual deiodinase activity
accumulates in stage 4 and 5 CKD.
Accumulation of toxic uremic solutes alter the hypothalamic
pituitary gland: TSH is subnormal.
Saturday, December
10, 2016
Pharmaceutical Seminar-4 12
School of Health and Allied Sciences
Pokhara University
Cont…
Undiagnosed and untreated hypothyroidism is poisoning
danger in many ways:
First: ESRD patient have a well recognized increase risk of
cardiovascular disease (10 fold higher mortality rates).
Second: hypothyroidism impairs myocardial function. In CKD
patients cardiac function can be already challenged by fluid
overload, overt hypertension anemia etc.
Third: neurobehavioral and neuromuscular dysfunction.
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10, 2016
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School of Health and Allied Sciences
Pokhara University
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10, 2016
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School of Health and Allied Sciences
Pokhara University
CONCLUSION
In present study we have found high prevalence of
subclinical and clinical hypothyroidism among
hemodialysis patients, 26.6% of the study subjects
had TSH levels above the reference range.
It was also shown that cold intolerance, constipation,
dry skin and the presence of tingling sensation were
much more common among patients with high TSH
levels.
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10, 2016
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School of Health and Allied Sciences
Pokhara University
Cont…
The diagnosis of hypothyroidism can be easily
missed in the ESRD population, because the
symptoms of CKD and hypothyroidism overlap.
Timely diagnosis and treatment of hypothyroidism
may prevent deterioration of patient condition and
prolong survival.
Knowing the high prevalence, clinicians should pay
attention on this factor and screen routinely for
thyroid function disorders in the CKD population.
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10, 2016
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School of Health and Allied Sciences
Pokhara University
REFERENCE
Paudel K (2014) Prevalence and clinical
characteristics of hypothyroidism in a population
undergoing maintenance hemodialysis. Journal of
clinical and diagnostic research; 8(4), MC01-MC04.
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10, 2016
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