慢性肾功能衰竭患者合并原发性甲状腺功能减退(附23例报告)

Chronic Renal Failure Complicated by Primary Hypothyroidism

目的:探讨慢性肾功能衰竭(CRF)合并原发性甲状腺功能减退(甲减)的临床特征。方法:用放射免疫法测定23例CRF合并甲减患者的甲状腺功能、甲状腺微粒体抗体(TM)、甲状腺球蛋白抗体(TG)及检测血清钙(Ca)、血清磷(P)、血清钾(K)、血清胆固醇(Ch)、血清肌酐(Cr)、血糖、尿素氮、血红蛋白(Hb)、内生肌酐清除率(Ccr)并与31例单纯CRF患者对照进行分析。结果:CRF合并甲减血清促甲状腺激素(TSH)、Ch、Ca均高于对照组,血清游离T4(FT4)、K、P低于对照组,余项指标差别无显著性。TG、TM2例升高。结论:CRF合并甲减最可靠的诊断依据是TSH升高并大于正常高限2倍以上,其次是FT4降低、Ca、P、K基本正常及Ch、TG、TM升高并需结合临床表现诊断。

Objective:To investigate the clinical features of chronic renal failure (CRF) complicated by primary hypothyroidism. Methods:Thyroid function,thyroid microsome antibody (TM),and thyroid globulin antibody (TG) were determined with radioimmunoassay in 23 CRF complicated by primary hypothyroidism patients,and the serum calcium,phosphorus,potassium, cholesterol, glucose, urea nitrogen, hemoglobulin,and endogenous creatinine clearance rate were also assayed. Thirty-one patients with only CRF were in control group. Results:The level of thyroid-stimulating hormone (TSH) ,Ch,and Ca in patients with CRF complicated by primary hypothyroidism were higher than that in control group,and serum free T4 (FT4), K,and P were lower than that in control group. The others had no difference between two groups. TG and TM increased in 2 cases. Conclusion: The most important criteria in diagnosing CRF complicated by primary hypothyroidism is TSH two times higher than normal upper limit. The others include decreased FT4,normal level of Ca,P,and K,and increased Ch, TG,and TM. The diagnosis should be performed combined with clinical manifestations.