Correlation of Thyroid Hormone Profile with Biochemical Markers of Renal Function in Patients with Undialyzed Chronic Kidney Disease

Measurement of free fraction, total concentration and protein binding for testosterone, triiodothyronine and thyroxine

Aims: Measuring the total and free concentrations of hormones is useful, but the technology to do this simultaneously is lacking. Methods: A new method offers the ability to measure these parameters concurrently for testosterone, thyroxine and triiodothyronine. Results: The free concentrations showed significant correlations with patients' vital statistics. Overall, 67% of correlations for total concentration showed that the new and classical methods had equal accuracy, or that comprehensive ultrafiltration was more accurate. The protein binding term was found to correlate significantly with the patients' luteinizing hormone, prostate-specific antigen and height. Conclusion: Comprehensive ultrafiltration for measuring the total concentration, free concentration and protein binding term uses less sample and is much faster than measuring these parameters with three separate methods.

Prediction and associated factors of hypothyroidism in systemic lupus erythematosus: a cross-sectional study based on multiple machine learning algorithms

OBJECTIVES

The prevalence of hypothyroidism in systemic lupus erythematosus (SLE) is significantly higher than that in the common public. While SLE itself can affect multiple organs, abnormal thyroid function may exacerbate organ damage in patients with SLE. We aimed to predict abnormal thyroid function and to examine the associated factors with multiple machine learning approaches.

METHODS

In a cross-sectional study, 255 patients diagnosed with SLE at the rheumatology department in Xiangya Hospital between June 2012 and December 2016 were investigated. Feature engineering was used for filtering out principle clinical parameters, and five different machine learning methods were used to build prediction models for SLE with hypothyroidism.

RESULTS

Feature engineering selected 11 variables with which to build machine learning models. Among them, random forest modelling obtained the best prediction performance, with an accuracy rate of 88.37 and an area under the receiver operating characteristic curve of 0.772. The weights of anti-SSB antibody and anti-dsDNA antibody were 1.421 and 1.011, respectively, indicating a strong association with hypothyroidism in SLE.

CONCLUSIONS

Random Forest model performed best and is recommended for selecting vital indices and assessing clinical complications of SLE, it indicated that anti-SSB and anti-dsDNA antibodies may play principal roles in the development of hypothyroidism in SLE patients. It's feasible to build an accurate machine learning model for early diagnosis or risk factors assessment in SLE using clinical parameters, which would provide a reference for the research work of SLE in China.

The Correlation Between Low Serum T3 Levels and All-Cause and Cardiovascular Mortality in Peritoneal Dialysis Patients

Objective

This study is to investigate the correlation between serum triiodothyronine (T3) levels and all-cause and cardiovascular mortality in PD patients.

Methods

A total of 376 end-stage renal disease (ESRD) patients who started maintenance PD treatment in the Department of Nephrology in our hospital and stable treatment for ≥3 months were selected, and the total T3 (TT3) and free T3 (FT3) levels were determined. Among them, 168 cases with FT3 <3.5 pmol/L and/or TT3 <0.92 nmol/L were divided into the low serum T3 level group, and the remaining 208 cases were divided into normal serum T3 level group. The Cox survival analysis method was used to analyze the correlation between low serum T3 levels and all-cause and cardiovascular mortality in PD patient.

Results

Compared with the normal serum T3 level group, patients with low serum T3 levels had higher systolic blood pressure and a higher proportion of heart disease, and lower levels of total T4, free T4, hemoglobin, serum albumin, blood calcium, serum total bilirubin, alanine aminotransferase, and 24-h urine volume (all P < 0.05). Binary Logistic regression analysis showed that heart disease (P = 0.003, OR: 2.628, 95% CI: 1.382–4.997) and high TT4 level (P < 0.001, OR: 0.968, 95% CI: 0.956–0.979) were related to low serum T3 levels in PD patients. Multivariate Cox regression analysis showed that low serum FT3 level was an independent risk factor for all-cause death in PD patients (HR = 0.633, 95% CI = 0.431–0.930; P < 0.020).

Conclusion

Low serum T3 levels in PD patients were associated with heart disease and TT4 levels. Low serum FT3 levels were associated with the risk of all-cause death in PD patients.

Association Between Serum Nitric Oxide Level and Changes in Thyroid Function Test in a Population-based Study: Tehran Thyroid Study Participants (TTS)

BACKGROUND

Nitric oxide (NO) plays a key role in thyroid function regulation through the inhibition of iodide (I) uptake at the thyroidal sodium-iodide symporter (NIS) and impacts on the thyroid vascularity and blood flow.

OBJECTIVES

This study aimed to evaluate the association between serum NO metabolites (NOx) and thyroid-stimulating hormone (TSH), free thyroxin (FT4), and anti-thyroid peroxidase (TPOAb) changes. Also, it aimed at evaluating the correlation between serum NOx and the incidence of clinical hypothyroidism, characterized by elevated TSH level and decreased FT4 concentration, and subclinical hypothyroidism, characterized by mildly elevated TSH level despite FT4 concentration within the normal range, over three years of follow-up.

METHODS

This study included 1,137 participants of the Tehran Thyroid study (TTS), aged > 20 years old, for whom data on serum TSH, FT4, and TPOAb in the third and fourth phases, and serum NOx in the third phase were available. Changes in TSH (ΔTSH), FT4 (ΔFT4), and TPOAb (ΔTPO) between the third and fourth phases were calculated, and the associations between serum NOx and ΔTSH, ΔFT4, and ΔTPOAb were assessed after multivariable adjustment using linear regression analysis.

RESULTS

No significant association was found between serum NOx and ΔTSH, ΔFT4, and ΔTPOAb after the multivariable adjustment; neither was any observed in TPOAb split groups after multivariable adjustment. No significant association was found between serum NOx tertiles and clinical and subclinical hypothyroidism incidence in the fourth phase of TTS.

CONCLUSIONS

There was no association between serum NOx levels and changes in TSH, FT4, and TPOAb and clinical and subclinical hypothyroidism incidence.

Cystatin C, Vitamin D and Thyroid Function Test Profile in Chronic Kidney Disease Patients

BACKGROUND

The progression of chronic kidney disease (CKD) is concomitant with complications, including thyroid dysfunction, dyslipidemia and cardiovascular diseases. The aim of this study is to determine serum cystatin C levels, and the prevalence of vitamin D deficiency and thyroid dysfunction in CKD patients.

METHODS

A cross-sectional study was conducted involving 140 CKD patients (stages 1-5) that were referred to a renal clinic. Demographic data was collected and thyroid function tests, serum 25-OH-vitamin D, cystatin C levels, and routine biochemistry tests were determined using cobas 6000 analyzer.

RESULTS

129 (92.1%) of CKD patients had elevated serum cystatin C levels and there was a stepwise increase from stage 1-5. Overt hypothyroidism was present in one patient and nine had subclinical hypothyroidism. There was a stepwise reduction in serum 25-OH-vitamin D levels from stage 2-5, 31 (22.1%) had vitamin D insufficiency and 31 (22.1%) presented with deficiency.

CONCLUSIONS

25-OH-vitamin D deficiency and thyroid disorders are exhibited in chronic kidney disease patients and the severity of the former rises with disease progression, as indicated by elevated cystatin C levels. Routine screening and timely intervention is recommended so as to reduce the risk of cardiovascular diseases.

Amine-modified kaolinite clay preserved thyroid function and renal oxidative balance after sub-acute exposure in rats

OBJECTIVES

Kaolinite clay is an abundant natural resource in Nigeria with several industrial applications. Incidentally, the wide-scale use of kaolinite clay is hampered by its small surface area. The objective of this study was to assess the effects of amine-modified clay on electrolyte, thyroid, and kidney function markers.

METHODS

Modification of kaolinite clay with an amine functional group was achieved using surface grafting technique. Characterization with a scanning electron microscope and Brunauer-Emmett Teller surface area analyzer confirmed this modification. However, there is sparse information on the effect of amine-modified kaolinite clay on electrolyte homeostasis, thyroid, and renal function. Rats were administered amine-modified kaolinite clay at the doses of 1, 2, and 5 mg/kg body weight.

RESULTS

After 14 days of repeated-dose treatment, there were no significant changes in levels of albumin, uric acid, triiodothyronine, thyroxine, ratio of triiodothyronine to thyroxine, and relative kidney organ weight. Furthermore, there were no changes in the concentration of potassium, although amine-modified kaolinite clay significantly decreased sodium, calcium, and total cholesterol levels. Amine-modified kaolinite clay, at all treatment doses, also preserved the renal histoarchitecture and oxidative balance in rats.

CONCLUSIONS

This study reports on the effect of amine-modified kaolinite clay on renal markers and thyroid function, and further deepens our understanding of their biochemical action. This baseline data may boost the prospect of using amine-modified kaolinite clay in the treatment of contaminated water.

Renal protective effects of grape seed extract treatment against Eltroxin-induced hyperthyroidism, kidney damage, and oxidative stress in male mice

The present study aimed to investigate the influence of grape seed extract (GSE) in renal toxicity, oxidative stress, and Bcl-2 expressions in Eltroxin-induced hyperthyroidism to male mice. GSE was evaluated through oral administration to male mice at dose 50 mg/kg daily for 3 consecutive weeks. Eltroxin (100 μg/kg) was administered to mice for 3 weeks, and the mice were posttreated with GSE for another 3 weeks. Results revealed that GSE administered to normal mice did not produce any signs of toxicity and did not cause any biochemical or histopathological changes. Posttreatment of Eltroxin-induced hyperthyroidism mice with GSE daily for 3 weeks improved all examined biochemical or histopathological features. Oral GSE can significantly normalize the elevated level of T3 and T4 in hyperthyroidism animals and elevated the reduced levels of TSH. Moreover, serum urea, creatinine, and electrolyte levels were significantly improved. GSE showed a potent antioxidant capacity in all oxidative stress markers assays (TBARS, reduced GSH, GST, SOD, and CAT) of kidney tissue homogenates. Furthermore, histopathological examination of kidney tissue of Eltroxin + GSE-treated group confirms the potential nephroprotective effect of GSE through increasing the anti-apoptotic marker Bcl-2.

Recombinant Human Thyrotropin Worsens Renal Cortical Perfusion and Renal Function in Patients After Total Thyroidectomy Due to Differentiated Thyroid Cancer

Background: Although thyrotropin (TSH) receptors are found in many nonthyroid tissues, we know little about the direct action of TSH on these receptors. Patients after total thyroidectomy for differentiated thyroid cancer (DTC) provide an interesting model for studying this issue. The administration of exogenous TSH in patients with an established thyroid state on levothyroxine (LT4) treatment allows us to study the effect of elevated TSH concentrations independent of thyroid status on the function of various organs, including the kidneys. The aim of this study was to assess the effects of the administration of recombinant human TSH (rhTSH) on renal perfusion and glomerular filtration in this group of patients. Methods: The study included 24 patients after total thyroidectomy due to DTC, without concomitant diseases, receiving only LT4 who qualified for radioiodine treatment (RIT). For two consecutive days, the patients received rhTSH and subsequently the RIT. Clinical and biochemical evaluation of thyroid and renal function was carried out before and 24 hours after the second dose of rhTSH and before the RIT. On the sixth day of hospitalization, the patients' glomerular filtration rate was re-evaluated. Kidney perfusion was assessed using color Doppler ultrasound imaging before and 24 hours after the second dose of rhTSH and before the RIT. Results: The administration of rhTSH to patients after total thyroidectomy due to DTC caused significant deterioration of renal perfusion after the second dose of rhTSH before the RIT, which was followed by a significant reduction in glomerular filtration. Furthermore, rhTSH did not significantly affect the hemodynamic parameters that could worsen renal function. Conclusions: This study indicates that TSH alone, independent of thyroid hormone concentrations, can influence renal perfusion and renal function.

Perfluoroalkyl acids and thyroid hormones across stages of kidney function

Data for US adults aged ≥20 years for 2007-2012 (N = 7020) were used to study concentrations of thyroid stimulating hormone (TSH), free (FT3) and total triiodothyronine (TT3), free (FT4) total thyroxine (TT4), and thyroglobulin (TGN) across stages of glomerular function (GF). Data for 2007-2008 and 2011-2012 (N = 2549) were used to study associations between thyroid hormone biomarkers and five serum perfluoroalkyl acids (PFAAs). We report how thyroid hormone biomarkers vary in human serum across stages of GF. Stages considered were: GF-1 (normal, eGFR >90 mL/min/1.73 m²), GF-2 (60 ≤ eGFR≤90 mL/min/1.73 m²), GF-3A (45 ≤eGFR<60 mL/min/1.73 m²), and GF-3B/4 (15 ≤ eGFR<45 mL/min/1.73 m²). Regression models stratified by GF stages were fitted to evaluate associations between the concentrations of selected PFAAs and thyroid hormones and to evaluate the variability in concentrations of thyroid hormones across the stages of GF. Adjusted geometric means (AGM) for TSH sharply increased from GF-1 (1.34 μIU/mL) to GF-2 (1.58 μIU/mL) and then remained relatively stable. AGMs of FT3 and TT3 decreased consistently from GF-1 to GF-3B/4; from 3.24 to 2.79 pg/mL for FT3 and from 115.7 to 96.4 ng/dL for TT3. AGMs for FT4 increased from GF-2 onward. TGN increased as glomerular filtration worsened from GF-1 through GF-3B/4. In contrast to strong relationships of thyroid hormone markers to stages of renal function, only scattered, inconsistent findings characterized relationship of PFAAs to thyroid markers across stages of kidney disease. For example, TSH was positively associated with PFOA at GF-2 (β = 0.08522, p < 0.01) but negatively associated at GF-3A (β = - 0.22926, p = 0.04). Thus, associations between kidney disease and thyroid hormone are clear, but the relationships between PFAAs and thyroid hormones vary inconsistently from stage to stage and reveal no trend. For thyroid hormone investigations, we conclude stratification by glomerular function stage is likely not needed.