Prevalence of secondary and tertiary hyperthyroidism in end stage renal disease patients - a single centre study

Abstract

Objective: to determine the prevalence of secondary and tertiary hyperthyroidism among patients with end-stage renal disease (ESRD) undergoing management at a single tertiary care center.

Methodology:  cross-sectional observational single-center study was carried out in the Dialysis Center from May 2023- June 2024. One hundred twenty-three subjects were enrolled in this study. All patients were on chronic hemodialysis treatment with different primary causes of renal failure, with a mean duration of hemodialysis therapy 5.6 ± 4.89 years. A complete clinical and biochemical profile was obtained for each patient. Conventional B-mode thyroid ultrasound was performed in all cases on Aixplorer Mach 30 (SuperSonic Imagine, France).The study aims to investigate the prevalence of morphological and functional thyroid disorders in patients with chronic kidney disease, with renal replacement therapy (hemodialysis).

Results: We evaluated 123 patients with end stage renal disease, with renal replacement therapy, with hemodialysis three times a week, mean age 62.2 ± 11.01 years. The mean duration of hemodialysis therapy was 5.6 ± 4.89 years. According to laboratory results we have found that 74.5% of patients from our study group were euthyroid, 24.4% percent were hypothyroid (16 females and 14 males),and 4 patients (3.3%) had subclinical hyperthyroidism. According to ultrasound results, 48.7% of patients have a normal thyroid appearance, 51.2% have a nodular goiter, defined as the presence of minimum one node in any thyroid lobe and 17.8% had autoimmune thyroiditis, with positive antibodies. The mean diameter of the nodules was 4.7 ± 11.1 mm, the maximum size found on ultrasound was 24.6 mm and the minimum dimension was 2 mm. Thyroid disease was more prevalent among female patients, who present a 3.4 fold higher risk. We have also found that an increase of BMI with one unit raises the risk of developing thyroid disease with 1.083 times (P = 0.018).

Conclusion: Chronic kidney disease and hemodialysis therapy have an impact on thyroid echo texture and morphology of thyroid gland. We have found that thyroid disease has a prevalence of 61.3% among patients with ESRD on hemodialysis, with a higher chance of developing thyroid disease for female gender, and the increase of body mass index raises the risk of developing thyroid disease by 1.083 times.