Hypothyroidism and functional state of the kidneys. clinical and pathogenetic aspects of the formation of chronic kidney disease

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Abstract

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.

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.

About the authors

Ilkhom T. Murkamilov

Kyrgyz State Medical Academy named after I.K. Akhunbaev; Salymbekov University

Author for correspondence.
Email: murkamilov.i@mail.ru
ORCID iD: 0000-0001-8513-9279

Dr.Sci. (Med.), Corresponding Member of the Russian Academy of Natural Sciences, Associate Professor, Department of Faculty Therapy, Director of the Multidisciplinary Medical Center «Doc University Clinic»

Kyrgyzstan, Bishkek; Bishkek

Kubanych A. Aitbaev

Salymbekov University

Email: aitbaev.kuban1940@gmail.com
ORCID iD: 0000-0003-4973-039X

Dr.Sci. (Med.), Professor, Consultant of the Department of Resuscitation, Therapy and Diagnostics, Multidisciplinary Medical Center 

Kyrgyzstan, Bishkek

Viktor V. Fomin

Sechenov First Moscow State Medical University (Sechenov University)

Email: fomin_vic@mail.ru
ORCID iD: 0000-0002-2682-4417

Dr.Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Faculty Therapy № 1, Vice-Rector for Innovation and Clinical Activities

Russian Federation, Moscow

Zafarbek R. Raimzhanov

N.N.Burdenko Main Military Clinical Hospital

Email: rzrmam@mail.ru
ORCID iD: 0000-0001-5746-6731

Neurologist, 29th Neurological Department

Russian Federation, Moscow

Furkat A. Yusupov

Osh State University

Email: furcat_y@mail.ru
ORCID iD: 0000-0003-0632-6653

Dr.Sci. (Med.), Professor, Head of the Department of Neurology, Neurosurgery and Psychiatry, Medical Faculty

Kyrgyzstan, Osh

Tursunoy F. Yusupova

Osh State University

Email: yusupova_tursunoy_f@mail.ru
ORCID iD: 0000-0002-8502-2203

Clinical Resident, Department of Neurology, Neurosurgery and Psychiatry, Medical Faculty

Kyrgyzstan, Osh

Abdulkhokim F. Yusupov

Osh State University

Email: furcat_y@mail.ru

Teaching Assistant, Department of Neurology, Neurosurgery and Psychiatry, Medical Faculty

Kyrgyzstan, Osh

Jaloliddin I. Solizhonov

Kazan State Medical University

Email: jaloliddinsolijonov44@gmail.com
ORCID iD: 0009-0003-0078-0609

6-year student, Faculty of Medicine

Russian Federation, Kazan

Komil K. Khabibullaev

Kyrgyz State Medical Academy named after I.K. Akhunbaev

Email: khabibullaevkomil2001@gmail.com
ORCID iD: 0009-0004-5508-8019

6-year student, Faculty of Medicine

Kyrgyzstan, Bishkek

Ibadilla A. Abdibaliev

Salymbekov University

Email: ibadilla_abdibaliev307@gmail.com

Researcher at the Department of Resuscitation, Therapy and Diagnostics, Multidisciplinary Medical Center

Kyrgyzstan, Bishkek

Altynay K. Baitelieva

Kyrgyz State Medical Academy named after I.K. Akhunbaev

Email: altynaibaitelieva.k@gmail.com
ORCID iD: 0000-0001-6668-9451

Cand.Sci. (Med.), Head of the department of Scientific, Innovative and Clinical Work

Kyrgyzstan, Bishkek

References

  1. Шилов Е.М., Шилова М.М., Румянцева Е.И. и др. Нефрологическая служба Российской Федерации 2024: Часть I. Заместительная почечная терапия. Клиническая нефрология. 2025;1:6–17. [Shilov E.M., Shilova M.M., Rumyantseva E.I. et al. Nephrology Service of the Russian Federation 2024: Part I. Renal Replacement Therapy. Clinical nephrology. 2025;1:6–17 (In Russ).]. doi: 10.18565/nephrology.2025.1.6-17.
  2. Камышова Е.С., Бобкова И.Н., Кахсуруева П.А. и др. Клинико-морфологические особенности идиопатической мембранозной нефропатии с фокально-сегментарным гломерулосклерозом. Терапевтический архив. 2024;96(6):580–6. [Kamyshova E.S., Bobkova I.N., Kakhsurueva P.А. et al. Idiopathic membranous nephropathy with focal segmental sclerosis. Therapeutic Archive. 2024;96(6):580–6 (In Russ).]. Doi: 10.26442/ 00403660.2024.06.202725.
  3. Муркамилов И.Т., Айтбаев К.А., Фомин В.В. Распространенность, возрастные и гендерные особенности хронической болезни почек у больных сахарным диабетом. Терапевтический архив. 2023;95(6):481–6. [Murkamilov I.T., Aitbaev K.A., Fomin V.V. Prevalence, age and gender features of chronic kidney disease in patients with diabetes mellitus. Therapeutic Archive. 2023;95(6):481–6 (In Russ).]. Doi: 10.26442/ 00403660.2023.06.202242.
  4. Мамедов М.Н., Оганов Р.Г., Мартынов А.И. Справочник по внутренним болезням. М., 2019. 480 с. [Mammadov M.N., Oganov R.G., Martynov A.I. Handbook of Internal Medicine, M., 2019. 480 p. (In Russ).].
  5. Taylor P.N., Albrecht D., Scholz A. et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat. Rev. Endocrinol. 2018;14(5):301–16. doi: 10.1038/nrendo.2018.18.
  6. Мартиросян Н.С., Петунина Н.А. Дисфункция щитовидной железы и вспомогательные репродуктивные технологии. Эффективная фармакотерапия. 2021;17(31):44–8. [Martirosyan N.S., Petunina N.A. Thyroid dysfunction and assisted reproductive technologies. Effective Pharmacotherapy. 2021;17(31):44–8 (In Russ).]. doi: 10.33978/2307-3586-2021-17-31-44-48.
  7. Свириденко Н.Ю., Косьянова Н.А. Субклинический гипотиреоз. Лечащий врач. 2006;10:58–61. [Sviridenko N.Yu., Kosyanova N.A. Subclinical hypothyroidism. The Attending Physician. 2006;10:58–61 (In Russ).].
  8. Ellervik C., Mora S., Ridker P.M., Chasman D.I. Hypothyroidism and Kidney Function: A Mendelian Randomization Study. Thyroid. 2020;30(3):365–79. doi: 10.1089/thy.2019.0167.
  9. Yu L., Lacorcia L., Johnstone T. Hyperthyroid cats and their kidneys: a literature review. Aust. Vet. J. 2022;100(9):415–32. doi: 10.1111/avj.13179.
  10. Kannan L., Shaw P.A., Morley M.P. et al. Thyroid Dysfunction in Heart Failure and Cardiovascular Outcomes. Circ. Heart Fail. 2018;11(12):e005266. doi: 10.1161/CIRCHEARTFAILURE.118.005266.
  11. Панфилова Е.А., Исаева М.П., Трошина Е.А. Гипотиреоз: лекция для врачей первичного звена. Медицинский совет. 2020;(11):124–30. [Panfilova E.A., Isaeva M.P., Troshina E.A. Hypothyroidism: a lecture for primary care physicians. Medical advice. 2020;(11):124–30. (In Russ).]. doi: 10.21518/2079-701X-2020-11-124-130.
  12. Трошина Е.А., Панфилова Е.А., Михина М.С. и др. Клинические рекомендации «Острые и хронические тиреоидиты (исключая аутоиммунный тиреоидит)». Проблемы эндокринологии. 2021;67(2):57–83. [Troshina E.A., Panfilova E.A., Mikhina M.S. et al. Clinical practice guidelines for acute and chronic thyroiditis (excluding autoimmune thyroiditis). Problems of Endocrinology. 2021;67(2):57–83. (In Russ).]. doi: 10.14341/probl12747.
  13. Мадиярова М.Ш., Моргунова Т.Б., Фадеев В.В. Лечение первичного гипотиреоза: нерешенные вопросы. Клиническая и экспериментальная тиреоидология. 2015;11(1):22–34. [Madiyarova M.M., Morgunova T.B., Fadeyev V.V. Treatment of primary hypothyroidism: unresolved issues Clinical and Experimental Thyroidology. 2015;11(1):22–34 (In Russ.).]. doi: 10.14341/ket201512234.
  14. Михалкова Д.Ю., Витебская А.В. Ревматологические маски гипотиреоза. Доктор.Ру. 2023;22(4):77–83. [Mikhalkova D.Yu., Vitebskaya A.V. Rheumatological masks of hypothyroidism. Doctor.Ru. 2023;22(4):77–83 (In Russ.).]. doi: 10.31550/1727-2378-2023-22-4-77-83.
  15. Liewendahl K., Helenius T., Lamberg B.A. et al. Free thyroxine, free triiodothyronine, and thyrotropin concentrations in hypothyroid and thyroid carcinoma patients receiving thyroxine therapy. Eur. J. Endocrinol. 1987;116(3):418–24. doi: 10.1530/acta.0.1160418.
  16. Diez J.J. Hypothyroidism in patients older than 55 years: Analysis of the etiology and assessment of the effectiveness of therapy. J. Gerontol. A Biol. Sci. Med. Sci. 2002;57(5):M315–20. doi: 10.1093/gerona/57.5.M315.
  17. Волкова А.Р., Дыгун О.Д., Абрамова И.М. и др. Дисфункция щитовидной железы при хронической болезни почек. Нефрология. 2019;23(1):60–6. [Volkova A.R., Dygun O.D., Abramova I.M. et al. Thyroid gland dysfunction in chronic kidney disease. Nephrology. 2019;23(1):60–6 (In Russ.).]
  18. Patil V.P., Shilpasree A.S., Patil V.S., et al. Evaluation of renal function in subclinical hypothyroidism. J. Lab. Physicians. 2018;10(1):50–5. doi: 10.4103/JLP.JLP_67_17.
  19. Болотова Е.В., Дудникова А.В., Кияницкая И.С. Хроническая болезнь почек у пациентов с нарушением функции щитовидной железы. Клиническая нефрология. 2020;12(4):70–4. [Bolotova E.V., Dudnikova A.V., Kiyanitskaya I.S. Chronic kidney disease in patients with impaired thyroid function. Clinical nephrology. 2020;4:70–4 (In Russ.)]. doi: 10.18565/nephrology.
  20. Орлова М.М., Родионова Т.И. Функциональное состояние почек у больных манифестным гипотиреозом. Саратовский научно-медицинский журнал. 2012;8(2):333–8. [Orlova M.M., Rodionova T.I. Functional state of kidneys in patients with clinical manifestations of hypothyroidism. Saratov J. Med. Sci. Res. 2012;8(2):333–8 (In Russ.)].
  21. Муркамилов И.Т., Айтбаев К.А., Фомин В.В. и др. Цитокины и артериальная жесткость на ранней стадии хронической болезни почек: взаимосвязь и прогностическая роль. Клиническая нефрология. 2018;4:25–32. [Murkamilov I.T., Aitbaev K.A., Fomin V.V. et al. Cytokines and arterial stiffness at the early stage of chronic kidney disease: the relationship and prognostic role. Clinical nephrology. 2018;4:25–32 (In Russ.)]. doi: 10.18565/nephrology.2018.4.25-32.
  22. Муркамилов И., Сабиров И., Айтбаев К., Фомин В. Роль провоспалительных цитокинов в развитии почечной дисфункции. Врач. 2020;31(2):33–7. [Murkamilov I., Sabirov I., Aitbaev K., Fomin V. The role of proinflammatory cytokines in the development of renal dysfunction. Vrach. 2 020;31(2):33–7 (In Russ.)]. doi: 10.29296/25877305-2020-02-07.
  23. Наниева А.Р., Хутугова И.А., Джиоев И.Г. и др. Функционально-морфологическое состояние почек при гипо- и гипертиреозе. Современные проблемы науки и образования. 2023;(5):94. [Nanieva A.R., Khutugova I.A., Dzhioev I.G. et al. Functional and morphological state of the kidneys in hypo- and hyperthyroidism. Modern problems of science and education. 2023;(5):94 (In Russ.)]. Doi:10 .17513/spno.32939.
  24. Peters J., Roumeliotis S., Mertens P.R., Liakopoulos V. Thyroid hormone status in patients with impaired kidney function. Int. Urol. Nephrol. 2021;53(11):2349 2358. doi: 10.1007/s11255-021-02800-2.
  25. Abdel-Wahhab K.G., Mourad H.H., Mannaa F.A. et al. Role of ashwagandha methanolic extract in the regulation of thyroid profile in hypothyroidism modeled rats. Mol. Boil. Rep. 2019;46(4):3637–49. doi: 10.1007/s11033-019 04721-x.
  26. Sue L.Y., Leung A.M. Levothyroxine for the Treatment of Subclinical Hypothyroidism and Cardiovascular Disease Frontiers in endocrinology. 2020;1:591588. doi: 10.3389/fendo.2020.591588.
  27. Afsar B., Yilmaz M.I., Siriopol D., et al. Thyroid function and cardiovascular events in chronic kidney disease patients. J. Nephrol. 2017;30(2):235–42. doi: 10.1007/s40620-016-0300-y.
  28. Вилков В.Г., Шальнова С.А., Конради А.О. и др. Факторы риска сердечно-сосудистых заболеваний при гипотиреозе в популяциях Российской Федерации и США. Профилактическая медицина. 2016;19(3):19 23. [Vilkov V.G., Shalnova S.A., Konradi A.O. et al. Cardiovascular risk factors in hypothyroidism in the populations of the Russian Federation and the USA. Rus. J. Prevent. Med. 2016;19(3):19 23 (In Russ.)]. doi: 10.17116/profmed201619319-23.
  29. Савищева А.А., Маль Г.С., Хачатрян В.А. Гипертриглицеридемия – современное состояние вопроса: эпидемиология, современный взгляд на проблему лечения (обзор литературы). Вестник новых медицинских технологий. 2025;1:74–82. [Savishcheva A.A., Mal’ A.A., Khachatryan V.A. Hypertriglyceridemia – current state of the issue: epidemiology, modern approach to treatment (literature review). J. New Med. Technol. 2025;1:74–82 (In Russ.)]. doi: 10.24412/1609-2163-2025-1-74-82.
  30. Шомин А.В., Сережина Е.К., Обрезан А.Г. Гипертриглицеридемия и ишемическая болезнь сердца: современный взгляд на проблему. Кардиология: новости, мнения, обучение. 2024;12(2):26–32. [Shomin A.V., Serezhina E.K., Obrezan A.G. Hypertriglyceridemia and coronary heart disease: a contemporary view at the problem. Cardiol.:News Opin. Training. 2024;12(2):26–32. (In Russ.)]. doi: 10.33029/2309-1908-2024-12-2-26-32.
  31. Драпкина О.М., Мазуров В.И., Мартынов А.И. и др. Консенсус для врачей по ведению пациентов с бессимптомной гиперурикемией в общетерапевтической практике. Кардиоваскулярная терапия и профилактика. 2024;23(1):3737. [Drapkina O.M., Mazurov V.I., Martynov A.I. et al. Consensus statement on the management of patients with asymptomatic hyperuricemia in general medical practice. Cardiovascular therapy and prevention. 2024;23(1):3737 (In Russ.)]. Doi: 10.15829/ 1728-8800-2024-3737.
  32. Rosato L., Avenia N., Bernante P. et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J. Surg. 2004;28(3):271–6.
  33. Курганов И.А., Богданов Д.Ю., Лукьянченко Д.В., Мамиствалов М.Ш. Проблема спайкообразования после неосложненной тиреоидэктомии и применение противоспаечных средств в хирургии щитовидной железы. Эндоскопическая хирургия. 2015;21(4):63 8. [Kurganov I.A., Bogdanov D.Iu., Lukianchenko D.V., Mamistvalov M.Sh. On the issue of adhesions after noncomplicated thyroidectomy and application of antiadhesive medications in thyroid surgery. Endoscopic Surgery. 2015;21(4):63 8 (In Russ.)]. doi: 10.17116/endoskop201521463-68.
  34. Grover G., Sadler G.P., Mihai R. Morbidity after thyroid surgery: patient perspective. Laryngoscope. 2013;123(9):2319–23.
  35. Fiorentino E., Cipolla C., Graceffa G. et al. Local neck symptoms before and after thyroidectomy: a possible correlation with reflux laryngo pharyngitis. Eur. Arch. Otorhinolaryngol. 2011;268(5):715–20.
  36. Фадеев В.В., Моргунова Т.Б., Мельниченко Г.А., Дедов И.И. Проект клинических рекомендаций по гипотиреозу. Клиническая и экспериментальная тиреоидология. 2021;17(1):4–13.[Fadeev V.V., Morgunova T.B., Melnichenko G.A., Dedov I.I. Draft of the clinical recommendations for diagnosis and treatment of hypothyroidism. Clinical and Experimental Thyroidology. 2021;17(1):4–13 (In Russ.)]. doi: 10.14341/ket12702.
  37. Фадеев В.В. По материалам клинических рекомендаций Американской тиреоидной ассоциации по лечению гипотиреоза. Клиническая и экспериментальная тиреоидология. 2014;10(4):9–19. [Fadeyev V.V. Comments to guidelines for the treatment of hypothyroidism prepared by the American thyroid association task force on thyroid hormone replacement. Clinical and experimental thyroidology.2014;10(4):9–19 (In Russ.)]. doi: 10.14341/ket20144919.
  38. Jonklaas J., Bianco A.C., Bauer A.J. et al. Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid. 2014;24(12):1670–751. doi: 10.1089/thy.2014.0028.

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