الفهرس 
Aim of the workOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
CKD has been known to affect the pituitary-thyroid axis and the peripheral metabolism of thyroid hormones. The kidney normally plays an important role in the metabolism, degradation and excretion of thyroid hormones. CKD affects thyroid function in many ways, including low circulating thyroid hormone levels, altered peripheral hormone metabolism, insufficient binding to carrier proteins, reduced tissue thyroid hormone content and altered iodine storage in the thyroid gland.There is a deep underlying relation between DM and thyroid dysfunction. A plethora of studies have evidenced an array of complex intertwining biochemical, genetic, and hormonal malfunctions mirroring this pathophysiological association. Hyperthyroidism and hypothyroidism have been associated with insulin resistance which has been reported to be the major cause of impaired glucose metabolism T2DM. In patients with proteinuria many other proteins beside albumin are lost in the urine. Among these are hormones and hormone-binding proteins. Several studies have documented urinary loss of thyroid hormones and thyroxin-binding globulin (TBG) in patients with proteinuria.In patients with the nephrotic syndrome, loss of thyroid hormones may lead to low free thyroid hormone levels unless production is increased under the influence of TSH. Furthermore, loss of albumin and TBG may reduce the binding capacity for thyroid hormones, resulting in a decrease in total T3 and T4 concentrations.This study included (120) CKD patients aged from 25 years to 70 years from Menofia university hospitals during the period from May 2015 to October 2015. They were classified into two groups: (I) (64 patients) (Diabetic group), (II) (56 patients) (Non-diabetic group). Each group was subdivided into 2 subgroups (A,B) according to creatinine clearance (CrCl): (A) (CrCl>45ml/min), (B) (CrCl<45ml/min). Members of the study were subjected to thorough history taking, complete physical examination and to kidney function testing (Scr, BUN), HbA1c, thyroid function tests (TSH, free T3, free T4), Tg, SA.The mean age in diabetic patients (group I) was 53.7 years while in non-diabetic patients (group II) was 46 years. The mean TSH for subgroup IA was 5.4 μIU/ml while subgroup IB was 1.4 μIU/ml and for subgroup IIA was 1.6 μIU/ml while for subgroup IIB was 2.1 μIU/ml. There was highly significant difference between subgroup IA and IB (p value=<0.001) and between subgroup IA and IIA (p value=<0.001). There was no significant difference between subgroup IIA and IIB (p value=0.658) and between subgroup IB and IIB (p value=0.467). This study shows that thyroid disturbance is more common in diabetic CKD patients than non-diabetic CKD patients and that hypothyroidism is more common in diabetic patients with early CKD stages than late CKD stages.