Severe Hypothyroidism Masquerading As Renal Impairment

甲狀腺機能低下症偽裝成腎臟功能不全

劉家珊(Chia-Shan Liu) ； 吳再坤(Tsai-Kun Wu) ； 尤英覽(Ying-Lan Yu) ； 簡孝文(Shiaw-Wen Chien) ； 白美安(Mei-An Tsai Pai) ； 郭元銓(Yuan-Chuan Kuo) ； 蔡政麟(Cheng-Lin Tsai) ； 林柏松(Paik-Seong Lim)

《Acta Nephrologica》 24卷2期 (2010/06) Pp. 114-118

摘要

雖然亞臨床原發性甲狀腺功能低下常見於慢性腎臟病患者，但是甲狀腺功能低下導致腎功能損害卻不常見。本篇報告一個三十三歲的年輕男性以腎功能的急速惡化來表現，患者主述有兩週的突發性位於兩側眼眶、面部和整個下肢的腫脹，並有輕微蛋白尿。他沒有典型明確症狀，卻顯示有嚴重甲狀腺失能的問題。由於切片報告與臨床表現的差異，引致我們評估其甲狀腺功能，而甲狀腺功能檢查顯示游離甲狀腺素(FT4)（濃度為9 pmol/L）較低、促甲狀腺激素(TSH)（濃度為237 uU／毫升）較高，符合嚴重甲狀腺功能低下症之診斷。治療甲狀腺功能低下的結果，能顯著且持續的降低血清肌酐的血中濃度。甲狀腺激素的不足已知可經由複雜病理生理機轉導致腎絲球過濾率(GFR)降低。因為大多數甲狀腺功能低下的臨床表現可能是細微的或缺之的，我們建議，在腎功能不全原因不明的患者應評估其甲狀腺的功能。

關鍵字

原發性甲狀腺機能低下症 ； 促甲狀腺激素 ； 腎絲球濾過率

並列摘要

Although subclinical primary hypothyroidism was common in patients with chronic kidney disease, renal impairment resulting from hypothyroidism was a rare occurrence. We described a 33-year-old young man who presented with rapid deterioration of renal function. He stated a two-week history of sudden onset of periorbital, facial and generalized leg swelling. Low-grade proteinuria was noted. There were no imminent symptoms suggestive of severe thyroid dysfunction. Discrepancy between the biopsy report and the clinical picture led to the assessment of thyroid function. Severe hypothyroidism with a low a free thyroxine (FT4) concentration (0.9 pmnol/L) and an elevated thyroid stimulating hormone (TSH) concentration (237 aU/mi) were found. Treatment of hypothyroid status resulted in a significant and sustained reduction of his serum creatinine level. Deficiency of thyroid hormones had been shown to reduce glomerular filtration rate (GFR) and its pathomechanism is multifactorial. Since the clinical manifestations may be subtle or avsent in most cases of hypothyroidism, we recommended that thyroid status should he assessed in patients with renal impairment of unknown cause.

並列關鍵字

Primary hypothyroidism ； Thyroid stimulatory hormone ； Glomerular filtration rate