甲状腺疾患と治療のジャーナル
オープンアクセス

概要

偶発性甲状腺機能低下症を伴う血液透析患者 - L-チロキシンへのアプローチ

Yee Yung Ng、Shiao Chi Wu、Chih Yu Yang、Fen Hsiang Hu、Chun Cheng Hou、Nai Yung Ku、Wen Chieh Wu、Tse-Jen Lien、Wu Chang Yang

Aim: This study investigated the effect of L-thyroxine on clinical manifestations and EPO responses, and the approach to L-thyroxine dosage adjustment for HD patients with Incidental hypothyroidism.

Methods: Ten cases of Incidental hypothyroidism were diagnosed in 695 HD patients. In this study, L-thyroxine therapy was given only to hypothyroid HD patients with clinical symptoms, hematocrit <35%, and whose hypothyroidism was caused by medications which could not be discontinued. The initial dosage of L-thyroxine was 0.025 mg daily, and continuous adjustment was made according to clinical manifestations, patient’s tolerance of L-thyroxine, and hematocrit level rather than TSH, T4 or FT4 value.

Results: Of the 10 cases of Incidental hypothyroidism, 2 were autoimmune-induced, 5 were non-autoimmuneinduced, 2 were amiodarone-induced, and 1 was interferon-induced. Among them, 7 were treated with L-thyroxine and 3 were not. After L-thyroxine therapy, all 7 patients got symptoms improvement with 3 having EPO dosage reduced by more than 20%, 3 having hematocrit increased by more than 20%, and no patient requiring blood transfusion to keep hematocrit >30%. The clinical manifestations were found to improve after discontinuation of medications in two of those three patients with medication-induced hypothyroidism. L-thyroxine therapy may not be required for HD patients with hypothyroidism and hematocrit >35%.

Conclusions: Adjustment of L-thyroxine dosage according to clinical manifestations, rather than TSH, T4 or FT4 value, is a practical and effective treatment approach for HD patients with hypothyroidism. This approach of L-thyroxine therapy could reduce EPO dosage, and improve both anemia and clinical symptoms.