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DOI: 10.1055/s-0037-1620965
Schilddrüsenfunktion bei dialysepflichtiger Niereninsuffizienz
Thyroid Function in Patients with Kidney Insufficiency Requiring HemodialysisPublication History
Eingegangen:
14 June 1980
Publication Date:
05 January 2018 (online)
Zusammenfassung
Es wurde bei 43 Hämodialysepatienten eine Untersuchung diverser Schilddrüsenfunktionsparameter vorgenommen. Als wesentlichstes Ergebnis fand sich eine charakteristische Befundkonstellation. Erniedrigten bzw. subnormalen Gesamthormonwerten im Serum standen normale freie Hormonspiegel gegenüber. Daneben fand sich eine verminderte Besetzung der Bindungsvalenzen des TBG und ein subnormales TSH. Der Ausfall des TSH-TRH-Testes war normal. Diese Konzentrationsänderungen im Serum lassen sich am ehesten durch das Vorliegen einer Modulation der Bindungsvalenzen der Transportproteine im Sinne einer Verminderung der Bindungsaffinität erklären. Es werden die möglichen auslösenden Mechanismen diskutiert und auf die hochgradige Störungsanfälligkeit der Bindungsvalenzen gegenüber Schwankungen des Säurebasengleichgewichtes und der Temperatur hingewiesen. Beide Faktoren könnten bei Urämiepatienten ursächlich eine gewisse Rolle spielen. Da sich jedoch nicht nur bei Urämiepatienten, sondern bei einer Reihe von anderen Erkrankungen derartige änderungen der Serumspiegel nachweisen lassen, ist die Wahrscheinlichkeit groß, daß unterschiedliche Mechanismen den gleichen Effekt auslösen.
Summary
In 43 hemodialysis patients different thyroid function parameters have been assessed. A characteristic combination of findings occurred in most cases. These were reduced values of total hormones in serum with normal free hormone levels. There was a reduced occupation of binding valences for TBG and a subnormal TSH. The TSH-TRH tests were normal. These changes in serum concentration can be explained at best by accepting a modulation of binding valences of transport proteins in the sense of reduced binding affinity. The various possible inducing mechanisms are discussed and the high sensitivity of binding valences to changes of the acid-alcaline equilibrium and temperature underlined. Both factors may play a role in uremic patients. Since not only in uremic patients but also in patients with various other diseases such changes in the serum level can be demonstrated, there is a good chance that different mechanisms induce the same effect.
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