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The relationship between thyroid dysfunction and kidney disease and its impact on cardiovascular mortality is known. Litle is known about thyroid dysfunction prevalence, symptoms, and response to therapy in Ecuadorian hemodialysis (HD) patients. The aims of study were to quantify prevalence, symptoms, thyroid ultrasound findings and treatment response of thyroid dysfunction in Ecuadorian HD patients.
Observational-retrospective study conducted in one HD center from Quito-Ecuador, from historical data studied since January to October 2023. Patients with analysis of at least 3 serum Thyroid Stimulant Hormone (TSH), one thyroid gland ultrasound (US) and complete data of treatment and dosage for thyroid dysfunction were recruited for analysis. POS-S renal scale was used to assess the presence of thyroid dysfunction symptoms. Patients were divided into three subgroups according to time of HD stay to compare prevalence of thyroid dysfunction between those groups. One group was composed for those patients with less than 3 years of HD stay, second group with patients between 3-6 years and the third group of those over 6 years of HD stay. SPSS 25.0 program was used for statistical analysis, T-student test was used to compare parametric quantitative variables, U-Mann-Whitney test was used as non-parametric test. Chi-square test was used to compare qualitative variables.
A total of 108 patients were included. At baseline TSH measurement 42,6% had hypothyroidism (TSH >5mU/l), with male predominance (61%, p=0,87), 1% with data for secondary hypothyroidism and 1% had hyperthyroidism. After six months prevalence reduced to 37% after hormonal substitution initiation. The most common symptoms found in patients with hypothyroidism were pain 48%, none 15%, constipation and reduced mobility with 9%. Patients with prolonged HD time (>6 years) had significatively higher prevalence of hypothyroidism (59%, p<0,001) when compared with patients with <3 years and those between 3 to 6 years. US abnormalities were found in 31% of hypothyroid patients. After treatment initiation, improvement of TSH levels was observed in 6% of patients treated at 6 months. Table 1 resumen findings of the study.
Prevalence of thyroid dysfunction in HD patients was high and with poor clinical correlation which suggests the need of periodical thyroid function screening with serum TSH and ultrasound tests (as image abnormalities were also common), emphasizing this conduct in patients with prolonged HD stay where hypothyroidism prevalence was significatively higher. Nephrology education programs should include knowledge in diagnosis and management of thyroid dysfunction on HD patients in collaboration with Endocrinology specialist for accurate treatment and follow-up.