S Trouillier1, I Delèvaux, N Rancé, M André, H Voinchet, O Aumaître. 1. Service de médecine interne, CHU Gabriel-Montpied, 58, rue Montalembert, B.P. 69, 63001 Clermont-Ferrand cedex, France. trouillier.s@club-internet.fr <trouillier.s@club-internet.fr>
Abstract
INTRODUCTION: If abnormal thyroid function indices have been reported in patients with nephrotic syndrome, hypothyroidism is exceptional. EXEGESIS: We report three adult patients (1, 2, 3) with hypothyroidism associated with nephrotic syndrome (minimal change glomerulonephritis [1], idiopathic membranous nephropathy stage I [2], stage II [3]). Glomerulopathy treatment and thyroid hormone replacement therapy were both initiated. Low replacement (1, 2) was sufficient when proteinuria decreased. It was higher when nephrotic syndrome was uncontrolled (3). CONCLUSION: Excessive thyroxine-binding protein and thyroxine urinary loss generate low rate of free thyroxine and elevated TSH. Systematic thyroid hormonal test is necessary if nephrotic syndrome is severe and prolonged.
INTRODUCTION: If abnormal thyroid function indices have been reported in patients with nephrotic syndrome, hypothyroidism is exceptional. EXEGESIS: We report three adult patients (1, 2, 3) with hypothyroidism associated with nephrotic syndrome (minimal change glomerulonephritis [1], idiopathic membranous nephropathy stage I [2], stage II [3]). Glomerulopathy treatment and thyroid hormone replacement therapy were both initiated. Low replacement (1, 2) was sufficient when proteinuria decreased. It was higher when nephrotic syndrome was uncontrolled (3). CONCLUSION: Excessive thyroxine-binding protein and thyroxine urinary loss generate low rate of free thyroxine and elevated TSH. Systematic thyroid hormonal test is necessary if nephrotic syndrome is severe and prolonged.