Hypothyroidism and functional state of the kidneys. Clinical and pathogenetic aspects of the formation of chronic kidney disease
Hypothyroidism (HT) is a clinical and laboratory syndrome caused by dysfunction of the thyroid gland (TG) and characterized by a polysyndromic course, especially in the clinical practice of internal medicine. By origin, there are primary, secondary and tertiary HT, by severity - subclinical, manifest (compensated and decompensated) and complicated HT. HT may be masked by various clinical syndromes: cardiovascular, gastrointestinal, neurological, rheumatological, hematological, gynecological and mental. Primary HT occurs in 95% of cases, most often caused by autoimmune thyroiditis or thyroid surgery. HT is especially common among elderly women. Manifest HT is accompanied by an increase in the level of thyroid stimulating hormone (TSH) and a decrease in the level of free thyroxine (fT4); subclinical HT is characterized by an increased level of TSH with normal fT4. HT is considered severe with a TSH level above 10.0 mIU/L, regardless of the fT4 level. HT is often accompanied by a decrease in renal blood flow and glomerular filtration rate (GFR); an inverse relationship has been established between the TSH level and GFR. In the presence of chronic kidney disease (CKD), the incidence of HT increases. Risk factors for CKD in patients with HT include hypercholesterolemia, dyslipidemia, hyperuricemia, elevated C-reactive protein and fibrinogen levels, and decreased blood albumin levels. The goal of replacement therapy is to achieve and maintain normal levels of TSH and thyroid hormones. The drug of choice for the treatment of HT is sodium levothyroxine (starting with doses of 12.5–75 mcg/day). In elderly patients with CKD and concomitant cardiovascular diseases, monotherapy with low doses of levothyroxine with gradual titration is preferable. It should be taken into account that in elderly individuals, the physiological level of TSH may be slightly higher than in young people, which determines the individualization of the target TSH level.Murkamilov I.T., Aitbaev K.A., Fomin V.V., Raimzhanov Z.R., Yusupov F.A., Yusupova T.F., Yusupov A.F., Solizhonov Zh.I., Khabibullaev K.K., Abdibaliev I.A., Baytelieva A.K.
Description of the clinical case. The article presents a clinical case of decompensated manifest HT in an elderly patient after subtotal thyroid resection. The relationship between anemia, cholelithiasis, hydropericardium and episodes of acute kidney injury with severe postoperative HT is demonstrated. HT in elderly patients often occurs latently against the background of comorbid pathology, which requires special alertness of the physician and timely correction of hormonal levels.
Keywords
thyroid dysfunction
hypothyroidism
clinical masks of hypothyroidism
thyroid-stimulating hormone
free thyroxine
kidney injury
creatinine
About the Authors
Ilkhom T. Murkamilov – Dr.Sci. (Med.), Corresponding Member of the Russian Academy of Natural Sciences, Associate Professor, Department of Faculty Therapy,KSMA n.a. I.K. Akhunbaev, Director of the Multidisciplinary Medical Center «Doc University Clinic», Salymbekov University. Address: 92 Akhunbaev st., Bishkek, 720020;
Tel.: (+996) 557-221-983; E-mail: murkamilov.i@mail.ru. ORCID: https://orcid.org/0000-0001-8513-9279.
Kubanych A. Aitbaev – Dr.Sci. (Med.), Professor, Consultant of the Department of Resuscitation, Therapy and Diagnostics, Multidisciplinary Medical Center «Salymbekov University». 144 Bokonbaev st., Bishkek, 720040; tel.: (+996) 555-758-476; e-mail: aitbaev.kuban1940@gmail.com. ORCID: https://orcid.org/0000-0003-4973-039X.
Viktor V. Fomin – Dr.Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Faculty Therapy
№ 1, N.V. Sklifosovsky Institute of Clinical Medicine, Vice-Rector for Innovation and Clinical Activities, Sechenov First Moscow State Medical University.
Address: 2 Bolshaya Pirogovskaya St., Moscow, 119991; tel.: 8 (495) 609-14-00, ext. 2142; E-mail: fomin_vic@mail.ru. ORCID: https://orcid.org/0000-0002-2682-4417.
Zafarbek R. Rayimzhanov – Neurologist, 29th Neurological Department, N.N. Burdenko Main Military Clinical Hospital, Address: 3 Hospitalnaya square, Moscow, 105094;
tel .: 8-499-263-55-55; E-mail: rzrmam@mail.ru. ORCID: https://orcid.org/0000-0001-5746-6731.
Furkat A.Yusupov – Dr.Sci. (Med.), Professor, Head of the Department of Neurology, Neurosurgery and Psychiatry, Medical Faculty, Osh State University.
Address: 331 Lenin st., Osh, 723500; Tel.: (+996) 990-999-291; E-mail: furcat_y@mail.ru. ORCID: https://orcid.org/0000-0003-0632-6653.
Tursunoy F. Yusupova – Clinical Resident, Department of Neurology, Neurosurgery and Psychiatry, Medical Faculty, Osh State University.
Address: 331 Lenin st., Osh, 723500; Tel.: (+996) 707-130-938; E-mail: yusupova_tursunoy_f@mail.ru. ORCID: https://orcid.org/0000-0002-8502-2203.
Abdulkhokim F. Yusupov – Teaching Assistant, Department of Neurology, Neurosurgery and Psychiatry, Medical Faculty, Osh State University.
Address: 331 Lenin st., Osh, 723500; tel.: (+996) 999-767-808; e-mail: furcat_y@mail.ru.
Zhaloliddin I. Solizhonov – 6-year student, Faculty of Medicine, Kazan State Medical University. Address: 49 Butlerov st., Kazan, 420012; tel.: (+495) 967-4690-0438; e-mail:jaloliddinsolijonov44@gmail.com. ORCID: https://orcid.org/0009-0003-0078-0609.
Komil K. Khabibullaev – 6-year student, Faculty of Medicine, KSMA n.a. I.K. Akhunbaev. Address: 92 Akhunbaev st., Bishkek, 720020; tel.: (+996) 706-474-201,
e-mail: khabibullaevkomil2001@gmail.com. ORCID: https://orcid.org/0009-0004-5508-8019.
Ibadilla A. Abdibaliev – Researcher at the Department of Resuscitation, Therapy and Diagnostics, Multidisciplinary Medical Center “Salymbekov University”.
Address: 144 Bokonbaev st., Bishkek, 720040; tel.: (+495) 926-765-7077, e-mail: ibadilla abdibaliev307@gmail.com
Altynay K. Baitelieva – Cand.Sci. (Med.), Head of the department of Scientific, Innovative and Clinical Work, KSMA named after. I.K. Akhunbaev. Address: 92 Akhunbaev st., Bishkek, 720020; tel.: (0312) 54-94-60, e-mail: altynaibaitelieva.k@gmail.com. ORCID: https://orcid.org/0000-0001-6668-9451.
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