alexa Hemodialysis Patients with Incidental Hypothyroidism -The Approach to L-thyroxine
ISSN: 2167-7948

Journal of Thyroid Disorders & Therapy
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Research Article

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
Tel: +886-2-2871-2121-2993
Fax: +886-2-2820-4735
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.
 

Abstract

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.

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