Thyroid stimulating hormone (thyrotrophin) and its relationship with chronic kidney disease before dialysis.

Abstract

Objective: To measure glomerular filtration rate, free thyroxin, and thyrotrophin in chronic kidney disease patients and to find out the correlation between glomerular filtration rates, free thyroxin and thyrotrophin in these patients. Study Design: Cross Sectional Analytical study. Setting: Bacha Khan Medical Complex Swabi. Period: November 2018 to November 2019. Material & Methods: Sixty five patients were included in the study.  Serum Creatinine, TSH and Free T4 were measured; Thyroid function tests TSH, FT4 were measured in these chronic kidney disease patients through enzyme linked immunosorbant assay method. GFR was calculated through Cock-croft-Gualt formula and the relevant data was entered in a predesigned Proforma. Results: In the study total 65 chronic kidney disease patients were taken. Out of which thirty six (55.4%) were male and twenty nine (44.6%) were female. Thirty five (53.8%) CKD patients whose TSH level was above the normal limit while in the remaining patients the TSH values were in the normal range. Eight patients (12.3%) out of sixty five patients in whom FT4 values were below the normal limit while in the remaining fifty seven patients (87.6%)  FT4 values were within the reference range. Those eight patients whose FT4 was below the normal value, their TSH values were above the normal value too. Thirty five patients, whose TSH levels were above the normal limit, their mean age was 50.60± 11.95, mean serum creatinine was 4.73± 2.94 mg/dl, mean GFR was 22.17± 12.48 ml/min/1.73m², mean TSH was 6.68± 0.87 mIU/L and mean FT4 was 0.97± 0.35 ng/dl. The p-value of TSH was < 0.001 and FT4 was < 0.05 in comparing with control group. Glomerular filtrations rate with TSH and FT4 the co-efficient of correlation (r) value for 35 patients was – 0.713 and 0.47 for TSH and FT4 respectively. Their p- values were 0.000 and 0.004 respectively, and p < 0.001 collectively. This was found to be statistically significant. Linear regression line was obtained between GFR and FT4 in CKD patients. Conclusion: chronic kidney disease is associated with biochemical thyroid dysfunctions causing most commonly subclinical hypothyroidism.