甲状腺病学和肾脏病学的横断面:文献综述和临床医生要点

IF 4.2 Q1 ENDOCRINOLOGY & METABOLISM
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引用次数: 0

摘要

临床医生在管理甲状腺疾病和肾病并存的患者时应考虑几个要点。甲状腺功能正常但患有慢性肾脏疾病(CKD)的患者可能会出现促甲状腺激素(TSH)正常偏高、游离甲状腺素(FT4)偏低、游离三碘甲状腺原氨酸(FT3)偏低和反向三碘甲状腺原氨酸(rT3)正常偏低的生理现象。慢性肾功能衰竭(CKD)患者中未经治疗的亚临床和原发性甲状腺功能减退症与肾功能衰竭的可逆性进展有关。为这些(慢性肾功能衰竭)患者补充左甲状腺素可以延缓肾功能衰竭的进展,预防终末期肾病(ESRD)。未经治疗的甲状腺机能亢进会使肾小球滤过率(GFR)增加18%至25%。因此,甲状腺功能亢进症的治疗可能会掩盖未确诊的慢性肾脏病患者。对于患有慢性肾脏病的患者,甲巯咪唑的剂量无需调整。不过,甲巯咪唑可能会在血液透析(HD)过程中被排出约30%至40%。甲状腺乳头状癌和 ESRD 患者的侵袭性特征发生率可能更高。患有慢性肾功能衰竭和 ESRD 的患者在接受 I-131 放射性碘治疗甲状腺癌时,由于碘的尿排泄量减少,会增加长时间辐射传播的风险。此外,ESRD 和甲状腺癌患者接受放射性碘 I-131 治疗的最佳剂量和时间也需要进一步研究。建议对这些患者进行剂量测量研究,并在核医学、肾病学和内分泌学之间进行多学科协调。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cross-section of thyroidology and nephrology: Literature review and key points for clinicians

There are several key points clinicians should consider when managing patients with overlapping thyroid and renal disease. Patients who are euthyroid and have chronic kidney disease (CKD) may physiologically have normal-high thyroid stimulating hormone (TSH), low free thyroxine (FT4), low free triiodothyronine (FT3) and normal-low reverse triiodothyronine (rT3). Untreated subclinical and primary hypothyroidism among patients with (CKD) is associated with reversible progression of renal failure. Supplementing these (CKD) patientswith levothyroxine can delay the progression of renal failure and prevent end stage renal disease (ESRD). Untreated hyperthyroidism increases the glomerular filtration rate (GFR) by 18 to 25%. Thus, the management of hyperthyroidism may unmask patients with undiagnosed CKD. There is no dosage adjustment required for methimazole among patients with CKD. However, methimazole may be eliminated during hemodialysis (HD) by around 30 to 40%. Patients with papillary thyroid cancer and ESRD may have higher rates of aggressive characteristics. Patients with CKD and ESRD undergoing radioiodine I-131 treatment for thyroid cancer are at increased risk of prolonged radiation transmission risk due to decreased iodine urinary excretion. Additionally, the optimal dosing and timing of radioiodine I-131 therapy amongst patients with ESRD and thyroid cancer requires further research. The use dosimetry studies and multidisciplinary coordination among nuclear medicine, nephrology and endocrinology is recommended for these patients.

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CiteScore
6.10
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24
审稿时长
16 weeks
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