The Ultrasonographic Observation Of Thyroid Gland In Patients With End-stage Renal Disease On Different Dialysis

Objective:High-frequency ultrasound was applied to observe the structure of thyroid gland in patients with end-stage renal disease on hemodialysis,peritoneal dialysis and non-dialysis,and discuss the relation between renal failure and different dialysis method with the abnormal changes of thyroid gland.Method:96 patients hospitalized in renal medicine at the second hospital of Jilin University for treatment of end-stage renal disease(ESRD)from May 2015 to October 2016 was involved.The patients were divided into three groups according to different dialysis methods:50 cases on hemodialysis(HD),24 cases on continuous ambulatory peritoneal dialysis(CAPD),22 cases on non-dialysis,and along with 37 selected people from physical center in the same period as controls.Dialyzed patients were divided into two subgroups according to with/without thyroid nodule: 49 cases with thyroid nodule,25 cases without thyroid nodule.Age,gender and primary disease of all patients were reviewed.Thyroid ultrasound examination of all participants was performed using high frequency PHILIPS i E33 probe.The size of thyroid gland was measured,the internal echo changes and whether there were nodules were observed by ultrasonography.The enlargement and abnormal structure of thyroid gland were judged according to corresponding standards.Blood samples were taken for determination of renal function,parathyroid hormone(PTH),thyroid hormone which including serum T3,total T4(TT4),Free T3(FT3),Free T4(FT4),thyroid-stimulating hormone(TSH).Results:1.The volume of thyroid gland and the ratio of thyroid gland enlargement of HD group,CAPD group and non-dialysis group were significantly larger than that of control group(P <0.05).2.The incidence of morphological disorders and thyroid nodules of HD group,CAPD group and non-dialysis group were significantly higher than that of control group(P <0.05);the incidence of multiple thyroid nodules of HD group was significantly higher than that of CAPD group,non-dialysis group and control group(P <0.05).The incidence of solid thyroid nodule of HD group and CAPD group was significantly higher than that of control group(P <0.05).The incidence of cystic-solid thyroid nodule of non-dialysis group was significantly higher than that of control group(P <0.05).3.The rate of thyroid dysfunction and low T3 syndrome of HD group,CAPD group and non-dialysis group were significantly higher than that of control groups(P <0.05).Serum FT3 and TT3 levels of HD,CAPD and non-dialysis groups were significantly lower than that of control group(P <0.05).4.Thyroid nodules in ESRD patients were more likely to appear in femals and elder persons.Conclusions:1.Functional and morphological disorders in thyroid gland were more common in patients with ESRD than in normal control.2.No significant difference was found in the improvement of thyroid functional and morphological disorders in patient with ESRD on different dialysis.3.The abnormal structure changes of thyroid gland in ESRD patients can be evaluated by ultrasonography objectively.Combined with the result of thyroid function,it can provide comprehensive information of thyroid in ESRD patients for clinic,and can provide the basis for treatment and prognosis.