Hemodialysis Patients with Incidental Hypothyroidism -The Approach to L-thyroxine
|Yee Yung Ng1*, Shiao Chi Wu2, Chih Yu Yang1, Fen Hsiang Hu3, Chun Cheng Hou4, Nai Yung Ku5, Wen Chieh Wu6, Tse-Jen Lien7 and Wu Chang Yang1|
|1Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, National Yang Ming University, School of Medicine, Taipei, Taiwan|
|2Institute of Health and Welfare Policy, National Yang Ming University, School of Medicine, Taipei, Taiwan|
|3Division of Nephrology, Wei-Gong Memorial Hospital, Miaoli County, Taiwan|
|4Division of Nephrology, Min-Sheng Hospital, Taoyuan, Taiwan|
|5Department of Medicine, Tung-Jen Hospital, Xindian City, Taipei County, Taiwan|
|6Dialysis center, Shin Loong Clinic, Panchiao City, Taipei County, Taiwan|
|7Dialysis Center, Jen Mei Clinic, Luzhou City, Taipei County, Taiwan|
|Corresponding Author :||Yee-Yung Ng
Division of Nephrology
Department of Internal Medicine Taipei Veterans
General Hospital and National Yang-Ming University
School of Medicine 201, Shih-Pai Road, Sec. 2, Taipei 112, Taiwan
E-mail: [email protected]
|Received September 25, 2013; Accepted November 20, 2013; Published November 22, 2013|
|Citation: Ng YY, Wu SC, Yang CY, Hu FH, Hou CC, et al. (2013) Hemodialysis Patients with Incidental Hypothyroidism -The Approach to L-thyroxine. Thyroid Disorders Ther 2:138. doi:10.4172/2167-7948.1000138|
|Copyright: © 2013 Ng YY, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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.