Relationship between Serum TSH Level and Nutritional Status in Maintenance Hemodialysis Patients / 대한신장학회잡지

ABSTRACT

Nutrition influences thyroid function. To investigate the association of malnutrition with thyroid function(especially serum TSH level), we performed cross-sectional study in 47 clinically stable HD patients. Thyroid function test[TSH and free T4 (FT4), anthropometry[triceps skinfold thickness (TSF), midarm muscle circumference MAMC), BMI, and fractional deviation from ideal weight(FW)], and biochemical parameters[serum albumin(SA), insulin- like growth factor-1(IGF-I) and lymphocyte count (LC)] were measured. All patients were euthyroid state(TSH 0.89+/-0.52, 0.19-2.82microU/ml; FT4 0.99+/-0.25, 0.38-1.89ng/dl). Patients were divided into two groups according to mean TSH level group I(>0.89U/ml, n=24) and group II(<0.89U/ml, n=23). Malnourished patients were significantly more(79.2 vs. 47.8%) and SA(4.0+/-0.5 vs. 4.4+/-0.3g/dl), IGF-I (174.5+/-76.7 vs. 229.3+/-89.6ng/ml), and BMI (20.8+/-2.5 vs. 22.3+/-2.1kg/m2) were significantly(p<0.05) lower in group I than in II. The proportions of patients with SA of <4.0g/dl and LC of <1200/mm3 (33.3 vs. 4.3%) and F delta W of <-0.10(29.2 vs. 4.3%) were significantly more in group I. Group I seemed to have longer duration of HD(53.3+/-37.2 vs. 36.0+/-28.7 months), lower FT4 (0.52+/-0.19 vs. 1.05+/-0.28ng/ dl) and LC(1239.3+/-455.6 vs. 1498.1+/-557.4 cells/ mm3), and more DM(20.8 vs. 4.3%) and number of patients with TSF(45.8 vs. 13.0%) and MAMC (41.7 vs. 17.4%) of <5 percentile of normal Korean value. TSH showed significantly negative correlation with SA(r=-0.34) and IGF-I(r=-0.35). In conclusion, inadequate HD and malnutrition seem to affect serum TSH level to minimize the energy expenditure in long-term HD patients.