What is the role of renal disease in the development of euthyroid sick syndrome?

Updated: Aug 28, 2020
  • Author: Serhat Aytug, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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The thyroid hormones may be affected by renal function in a variety of ways considering the heterogeneity of renal dysfunction and variations in renal function, which may have profound effects on thyroidal economy. Variation in thyroid function test findings also depends on the severity and duration of the disease. In chronic renal failure, total T4 and free T4 can be either normal or elevated, total T3 is reduced significantly, free T3 is reduced, rT3 is unchanged, basal TSH can be unchanged or elevated, and TSH response to TRH stimulation is decreased or delayed. Many of these abnormalities are reversed with kidney transplantation.

In nephrotic syndrome, clinical presentation and thyroid function test findings mimic hypothyroidism. Total T4 and free T4 levels can be normal or reduced (significant proteinuria or loss of TBG and concomitant steroid administration can explain reduced T4). Total T3 is reduced significantly, free T3 is reduced, and rT3 is unchanged. In contrast to primary hypothyroidism, basal TSH either is unchanged or increased slightly, while TSH response to TRH is decreased and delayed.

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