The Changes Of Serum Thyroid Hormone Levels And Its Clinical Observation In Patients With Primary Nephrotic Syndrome

Purpose:To compare the changes of serum thyroid hormone levels（TH）、thyroid stimulating hormone（TSH）in normal control group, primarynephrotic syndrome （PNS） patients before and after treatment.Thecorrelation between serum thyroid hormone levels and levels of serumalbumin（ALB）and24-hour urinary protein were analyzed. In order toinvestigate the clinical significance and possible mechanism of serum THchanges in patients with PNS,and exploring new ways to provide atheoretical basis for whether given these patients thyroid hormonesupplement and propose treatment and judge the prognosis.Materials and methods:1．The subjects：Sixty patients with PNS were selected who stayed inour hospital from January in2011to November in2011as observationgroup, this group was divided into PNS before treatment (group A) andPNS after treatment (group B) according to before treatment and aftertreatment; Patients after treatment whose24-hour urinary proteinexcretion＜0.3g，ALB≥35g/L were complete remission group(group C).And thirty cases of healthy volunteers were selected in our hospitalduring the same period as normal control group (group D). 2.(1)Criteria of diagnosis: Primary nephrotic syndrome diagnosticcriteria：24-hour urinary protein excretion>3.5g，serum albumin<30.0g/L，accompanied by edema and hyperlipidemia, exclude secondary factorsand the first two terms are necessary.(2)Observation group cases selected: the group of patients must bemet:①Exclude systemic lupus nephritis、hepatitis B virus associatedglomerulonephritis， anaphylactoid purpura nephritis， diabeticnephropathy and other secondary factors；②Before and after treatmentwere not using drugs that affect the metabolism of thyroid hormones；③No primary history of thyroid disease；④Not given blood purificationtreatment.(3)Control group of cases selected: The group of patients must bemet:①No important organ diseases such as liver, lung, and kidney, etc；②Never used drugs that affect the metabolism of thyroid hormonesbefore；③No primary history of thyroid disease.3.Observing indexes: The patients of observation group beforetreatment and control group in the diet patterns of life, The next morningafter12hours’ fasting, draw venous blood and inspected, measured serumthyrotropic-stimulating hormone(TSH), free triiodothyronine(FT3), freetetraiodothyronine(FT4),serum albumin； count the amount of urinespecimens of24hours, take10ml of urine to detect the24-hour urinaryprotein excretion. The patients of observation group before treatment whose serum FT3，FT4，TSH，ALB and24-hour urinary protein excretionwere reexamined after treatment for one year(including glucocorticoids,cell toxicity drugs，CsA，traditional Chinese medicine，etc).4．Statistical analysis: SPSS16.0statistics software was used fordata processing.2-test for Count data, measurement data was expressedby mean±standard deviation, Comparison of the measurement data ofbefore and after treatment using paired t-test, independent samples t-testfor other groups comparison；The correlation between serum thyroidhormone levels and levels of serum albumin and urinary protein usinglinear correlation analysis. P value<0.05was considered to havestatistical significance，P value<0.01was considered to have significantstatistical significance.Results:1．Changes of serum thyroid hormone levels in PNS patients beforetreatment：Serum FT3and FT4levels in PNS patients before treatmentwere lower than normal control group, serum TSH levels were higherthan normal control group, there were significant differences between thetwo groups(P<0.01).2．The correlation between serum thyroid hormone levels and levelsof serum albumin and urinary protein in PNS patients before treatment：Levels of serum FT3and FT4were positively correlated with serumalbumin（r1=0.591，r2=0.506, respectively，P<0.05）；while levels of serum TSH had no correlation with serum albumin（r=-0.092，P＞0.05）.Levels of serum FT3and FT4were negatively correlated with24hour urinary protein（r1=-0.374，r2=-0.490,respectively，P＜0.05）；whilelevels of serum TSH had no correlation with24hour urinary protein（r=0.083，P＞0.05）.3．Changes of serum thyroid hormones, serum albumin,24hoururinary protein levels in PNS patients before and after treatment：Levelsof24hour urinary protein in PNS patients before treatment was lowerthan after treatment，while serum albumin was higher than after treatment,there were significant differences between the two groups(P<0.01).Thelevels of serum FT3and FT4were increased and the levels of serum TSHdecreased with the improvement of the disease，there were significantdifferences between before and after treatment (P<0.01).4．Thyroid hormone levels in complete remission group comparedwith control group：36patients were achieved complete remission aftertreatment，the levels of serum FT3and FT4were increased and the levelsof serum TSH decreased.the levels were all in normal range, there wereno significant differences between complete remission group and normalcontrol group(P＞0.05).Conclusions:1．A decrease in the thyroid hormone levels in the patients withprimary nephrotic was found, the decreased levels of FT3and FT4were often precede the prognosis and severity of the disease.2．After the remission of primary nephrotic syndrome，the levels ofserum thyroid hormone were improved with the remission of the disease；The patients who achieved complete remission after treatment，theirthyroid hormone levels can return to normal，we don’t recommend to givethyroid hormone replacement therapy，but to treat the primary disease andto check thyroid hormones regularly.