patients of hypothyroidism were administered levothyroxine. Mean values of
control and hypothyroid group for creatinine were 0.86 and 0.03; for blood
urea: 17.14 and 29.37; for blood urea nitrogen: 7.99 and 13.69, and, for uric
acid: 5.46 and 6.42 for both groups i.e., control and hypothyroid group
respectively. The standard error of means for creatinine: +0.03 and +1.00;
for blood urea +0.92 and +2.94; for blood urea nitrogen: +0.43
and +1.37, and, for uric acid were +0.32 and +0.73 for
both groups i.e., control and hypothyroid group respectively. P-values were
identified by comparing hypothyroid group with control and those were 0.219,
0.004, 0.001 and 0.192 for creatinine, blood urea, blood urea nitrogen and uric
serum creatinine levels in hypothyroid patients decreased to normal levels
after treatment with levothyroxine. Statistical analysis also confirmed the
results since p-value for creatinine was 0.219 when analyzed for both study
groups. Thus, creatinine levels are instantly affected by thyroid status due to
effect of thyroid hormones on creatinine synthesis by kidney cells secretion
via glomerulus (Den Hollander JG et al., 2005 and Devika T et al., 2009).
urea levels, for control and hypo groups, were found statistically significant
with p-value 0.004 representing drug inefficacy to normalize urea levels in
hypo group. These raised levels of serum urea are due to possible side effects
of L-Thyroxine (Den Hollander et al., 2005).
levels of uric acid were appeared to be normal after treatment with
levothyroxine. Statistical assessment also proved the non-significant
difference between control and hypo group. P-value of 0.192 shows the strong
effect of drug indirectly on kidney because as the levels of thyroid hormone
gets normal, kidney function also tends to be normal. Further we can validate
our results by findings of previous studies in establishing a strong
correlation between uric acid levels and abnormal thyroid status and effect of
L-thyroxine in normalizing thyroid function directly and uric acid levels
indirectly (Nakahama H et al., 2001 and Obermayr RP et al.,
and standard error of mean values of hyperthyroid patients with carbimazole
treatment were as follows: for creatinine: 0.94 and +0.04; for blood
urea: 25.73 and +1.06; for blood urea nitrogen: 11.99 and +0.49,
and, for uric acid: 5.63 and +0.26. While on treating hyperthyroid
patients with propylthiouracil, mean and standard error of mean values for
creatinine were: 0.88 and +0.06; for blood urea: 22.30 and +0.45;
for blood urea nitrogen: 10.39 and +0.21, and, for uric acid: 4.58 and +0.54.
Significance or insignificance was established on the basis of p-values after
comparing whole group of hyperthyroid patients with control population and
those were 0.337, 0.020, 0.010 and 0.198 for creatinine, blood urea, blood urea
nitrogen and uric acid respectively.
and uric acid levels were also appeared to be non-significant with p-value of
0.337 and 0.198 respectively. Since the patients included in hyperthyroid group
were on anti-thyroid medication and this medication normalized their T4, T3 and
TSH so creatinine and uric acid, whose levels are dependent on thyroid profile,
also become normalized. Our research findings on Pakistani population are
clearly strengthening the previously held notion of renal dependency on thyroid
gland as documented by den-Hollander and his coworkers during 2005 that renal
anomalies improve as abnormal thyroid function gets better by using
anti-thyroid drugs (Iseki K et al., 2001, Den Hollander JG et al., 2005 and Devika T et al., 2009).
urea levels were found to be significant in our study with a p-value of 0.020
when control group was compared with hyperthyroid group through statistical
analysis. This increase in urea level was due to side effect of carbimazole and
propylthiouracil when used for a long duration as reported in different studies
in various timings. Similarly Clara Day and his co-workers presented a case
report in 2003 when a male patient under treatment with carbimazole experienced
elevated blood urea nitrogen levels. High blood urea nitrogen has also been
reported as a side effect of propylthiouracil (Fang T and Chiu-Ching H 1998, Clara
D et al., 2003 and Frenais R et al., 2009).
CONCLUSION & FUTURE PERSPECTIVE
treatment of hypothyroid patients, combination therapy must be recommended to
effectively treat the disorder and increase the social and psychological status
of the patient. The patients of hyperthyroidism on carbimazole and
propylthiouracil may present disturbed renal markers as the associated effects
of these drugs, so, adjunctive therapy should be employed to mask related side
effects. Furthermore, patients coming with renal disorders must also be
examined for thyroid abnormalities so that culprit cause of this renal
abnormality could be treated.
would like to acknowledge Prof Dr MH Qazi for his support and interest in this
study. Special thanks to Zahra Batool for her entire efforts and hard work
during the course of completion and we are also thankful to CENUM, Mayo
Hospital Lahore for their continuous participation in this project.
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