اضطراب الهرمونات الدرقية عند مرضى القصور الكلوي المزمن
Abstract
تم قياس المستويات المصلية الكلية للتيروكسين (TT4) وتري أيودوتيرونين (TT3) وT3 الحر (FT3) وT4 الحر (FT4) والتيروتروبين (TSH) عند (97) مريضاً بدرجات مختلفة من القصور الكلوي المزمن, و(21) شخص سليم, قسّم المرضى أسوياء الدرق سريرياً (70مريضا) والمرضى الأصحاء إلى ثلاث مجموعات:
مجموعة I: تحتوي على 40 مريضاً على العلاج المحافظ.
مجموعة II: تحتوي على 30 مريضاً على التحال الدموي.
مجموعة III: وتضم 21 شخصا سليماً.
أظهر مرضى المجموعة I والمجموعة II نقصاً هاماً في مستويات FT3,TT4,TT3, بالمقارنة مع الأصحاء بينما لم تنبدل قيم TSH,FT4 بشكل هام، وتناقصت مستويات FT3,TT4,TT3 مع ازدياد الأذية الكلوية.
أظهر مرضى المجموعة II نقصاً هاماً في مستويات FT4,TT4,FT3,TT3 بالمقارنة مع مرضى المجموعة I.
اختبارات عديدة لوظيفة الدرق كانت غير طبيعية عند مرضى القصور الكلوي المزمن، ولكن قيم TSH,FT4 كانت طبيعية عند جميع المرضى أسوياء الدرق، على كل حال إن وجود مستويات سوية لـ TSH،FT4 يشير لحالة سواء درقي وظيفي.
إضافة لذلك وجد قصور الدرق عند (8) أشخاص من أصل (97) مريضا تم استقصاؤهم، بينما لم نجد قصور درق عند أي شخص من المجموعة III.
The levels of serum total thyroxin (TT4)، triiodothyronin (TT3)، free T3 (FT3)، free T4 (FT4) and thyrotropin (TSH) were measured in 97 patients with varying grades of chronic renal failure; and 21 healthy individuals. The clinically euthyroid patients (70 patients) and healthy individuals were grouped as: Group I containing 40 patients on conservative management; GroupII containing 30 patients on hemodialysis therapy; and GroupIII (normals).
Group I patients and groupII patients showed significant decrease in TT3، TT4، and FT3 levels as compared to normals، wherease FT4 and TSH values were not significantly altered. TT3،TT4 and FT3 levels reduced as the severity of renal damage increased.
GroupII patients showed significant decrease in TT3، FT3، FT4، and TT4 levels as compared to group I.
Several thyroid function tests are abnormal in chronic renal failure patients، but FT4 and TSH values were normal in all euthyroid patients، however، finding of normal FT4 and TSH levels would indicate functional euthyroid status.
Moreover، there were 8 patients of the 97 patients we had screened who had hypothyroidism، whereas non of group III patients had hypothyroidism.
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