Prevalence and clinical characteristics of hypothyroidism in a population undergoing maintenance hemodialysis

Evaluation of Age and Gender-Related Patterns in Clinical Features and Hematological Findings Among Hypothyroidism Patients in the Al-Jouf Region of Saudi Arabia: A Hospital-Based Study

BACKGROUND

The prevalence of hypothyroidism is high in Saudi Arabia and the contributing factors are iodine deficiency and lack of balanced nutrition. This study aims to correlate the gender, age, and presence of co-morbidities with the laboratory findings and clinical presentation.

METHODOLOGY

A cross-sectional study was done in the hospitals of the Al-Jouf region. The files of the patients diagnosed with hypothyroidism from the last two years were retrieved by non-probability consecutive sampling technique. IBM SPSS Statistics for Windows, Version 23, (Released 2015; IBM Corp., Armonk, New York, United States) was used for data entry and analysis. Descriptive statistics were presented as frequencies and proportions (for qualitative variables) and mean and standard deviation (SD) (for continuous data). Associated factors were identified through a chi-square test. A p-value less than 0.05 was considered statistically significant.

RESULTS

Most of the patients were females within the age group of 36 to 50 years. Significant differences were observed between male and female patients with respect to the FT4 levels, hemoglobin (Hb) levels, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) values, and RBC counts (p-values of <0.001, <0.001, <0.001, <0.001, <0.001 and <0.001, respectively). However, no significant differences were observed between male and female patients in the TSH levels and hematocrit values. Most of the patients were euthyroid (77.24%). The pattern of thyroid function status did not show significant differences with respect to the gender of participants and the different age groups (p-values of 0.447 and 0.775, respectively). The most common co-morbidities observed were diabetes and hypertension. No significant association between the co-morbidities and the pattern of thyroid function status was observed. The most common symptoms were epigastric pain, fatigue, constipation, drowsiness, altered bowel habits, and weight gain.

CONCLUSION

This hospital-based study provides valuable insights into some epidemiological characteristics, clinical features, and hematological findings in hypothyroidism patients of the Al-Jouf region. Significant differences were observed between male and female patients with respect to the FT4 levels, Hb levels, MCV, MCH, MCHC values, and RBC counts. The findings strengthen the existing knowledge base and emphasize the importance of timely detection and management of hypothyroidism in this population. Implementation of salt iodination programs and a timely evaluation of the hematological parameters is recommended. Further research is warranted to delve into the hidden mechanisms and long-term ramifications of hematological changes associated with hypothyroidism.

Prospective role of thyroid disorders in monitoring COVID-19 pandemic

COVID-19 pandemic has affected more than 200 countries and 1.3 million individuals have deceased within eleven months. Intense research on COVID-19 occurrence and prevalence enable us to understand that comorbidities play a crucial role in spread and severity of SARS-CoV-2 infection. Chronic kidney disease, diabetes, respiratory diseases and hypertension are among the various morbidities that are prevalent in symptomatic COVID-19 patients. However, the effect of altered thyroid-driven disorders cannot be ignored. Since thyroid hormone critically coordinate and regulate the major metabolism and biochemical pathways, this review is on the potential role of prevailing thyroid disorders in SARS-CoV-2 infection. Direct link of thyroid hormone with several disorders such as diabetes, vitamin D deficiency, obesity, kidney and liver disorders etc. suggests that the prevailing thyroid conditions may affect SARS-CoV-2 infection. Further, we discuss the oxidative stress-induced aging is associated with the degree of SARS-CoV-2 infection. Importantly, ACE2 protein which facilitates the host-cell entry of SARS-CoV-2 using the spike protein, are highly expressed in individuals with abnormal level of thyroid hormone. Altogether, we report that the malfunction of thyroid hormone synthesis may aggravate SARS-CoV-2 infection and thus monitoring the thyroid hormone may help in understanding the pathogenesis of COVID-19.

Thyroid function in end stage renal disease and effects of frequent hemodialysis

INTRODUCTION

End-stage renal disease (ESRD) is associated with perturbations in thyroid hormone concentrations and an increased prevalence of hypothyroidism. Few studies have examined the effects of hemodialysis dose or frequency on endogenous thyroid function.

METHODS

Within the Frequent Hemodialysis Network (FHN) trials, we examined the prevalence of hypothyroidism in patients with ESRD. Among those with endogenous thyroid function (without overt hyper/hypothyroidism or thyroid hormone supplementation), we examined the association of thyroid hormone concentration with multiple parameters of self-reported health status, and physical and cognitive performance, and the effects of hemodialysis frequency on serum thyroid stimulating hormone (TSH), free thyroxine (FT4), and free tri-iodothyronine (FT3) levels. Conventional thrice-weekly hemodialysis was compared to in-center (6 d/wk) hemodialysis (Daily Trial) and Nocturnal (6 nights/wk) home hemodialysis (Nocturnal Trial) over 12 months.

FINDINGS

Among 226 FHN Trial participants, the prevalence of hypothyroidism was 11% based on thyroid hormone treatment and/or serum TSH ≥8 mIU/mL. Among the remaining 195 participants (147 Daily, 48 Nocturnal) with endogenous thyroid function, TSH concentrations were modestly (directly) correlated with age (r = 0.16, P = 0.03) but not dialysis vintage. Circulating thyroid hormone levels were not associated with parameters of health status or physical and cognitive performance. Furthermore, frequent in-center and nocturnal hemodialysis did not significantly change (baseline to month 12) TSH, FT4, or FT3 concentrations in patients with endogenous thyroid function.

DISCUSSION

Among patients receiving hemodialysis without overt hyper/hypothyroidism or thyroid hormone treatment, thyroid indices were not associated with multiple measures of health status and were not significantly altered with increased dialysis frequency.

Thyroid dysfunction and dyslipidemia in chronic kidney disease patients

BACKGROUND

Chronic kidney disease (CKD) is becoming a serious health problem; the number of people with impaired renal function is rapidly rising. Progression of CKD is associated with having a number of complications, including thyroid dysfunction, dyslipidemia and cardiovascular diseases. This study was conducted to investigate thyroid function and lipid profile in CKD patients.

METHODS

A cross-sectional study was conducted among 360 chronic kidney disease patients at B P Koirala Institute of Health Sciences, Dharan, Nepal. Demographic features (age and sex) and medical history of diabetes mellitus, hypertension and cardiovascular diseases of each patient were noted, and blood samples (5 ml) were analyzed for serum urea, creatinine, glucose, free triiodothyronine (T3), free thyroxine (T4), thyroid stimulating hormone (TSH), total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and triglyceride.

RESULTS

Thyroid dysfunction was found in 38.6 % CKD patients, the most common being subclinical hypothyroidism (27.2 %), followed by overt hypothyroidism (8.1 %) and subclinical hyperthyroidism (3.3 %). Hypercholesterolemia, low HDL cholesterol, undesirable LDL cholesterol and hypertriglyceridemia were observed in 34.4, 34.1, 35 and 36.6 % patients respectively. Stage 4 and 5 CKD patients had significantly higher risk of having thyroid dysfunction as compared to stage 3 patients. Significant risk factors for cardiovascular disease in CKD patients included presence of diabetes mellitus, hypercholesterolemia, undesirable LDL cholesterol and being in stage 4 and 5 (as compared to stage 3).

CONCLUSIONS

Thyroid dysfunction, hypercholesterolemia, low HDL cholesterol, undesirable LDL cholesterol and hypertriglyceridemia are common in CKD patients. Progression of CKD is accompanied by rise in hypothyroidism and cardiovascular disease.