만성 신질환에서 갑상선기능 저하증의 빈도
Prevalence of Hypothyroidism in Patients with Chronic Kidney Disease
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초록
임상적으로 갑상선 기능 저하증의 증상과 만성 신질환의 증상은 감별하기가 어려우며, 만성 신질환에서 갑상선 기능저하증의 유병률이 높은 점을 고려하여 만성 신질환 환자를 진료할 때 이에 대한 가능성을 염두에 두어야 할 것으로 생각한다. 향후 만성 신질환과 갑상선 기능 저하증 발생의 인과관계, 만성 신질환에서 갑상선 기능 저하증이 심혈관계 합병증에 미치는 영향, 만성 신질환에서 갑상선 기능의 주기적 검진에 대한 임상적 의의에 대해서는 추가적인 연구가 필요할 것으로 생각한다.
Abstract
Chronic kidney disease (CKD) affects both hypothalamus-pituitary-thyroid axis and peripheral metabolism of thyroid hormones. CKD is associated with a higher prevalence of both overt and subclinical primary hypothyroidism. Recent studies have shown that the prevalence of primary hypothyroidism, mainly in the subclinical form, increases as GFR decreases. In this issue of the journal, Lee et al. reported that the prevalence of overt hypothyroidism increased from 0.5% at an estimated GFR > 90 mL/min per 1.73 m2 to 6.3% at ESRD requiring dialysis, and it is independently associated with progressively lower estimated GFR. However, additional large, community based studies will be required to determine the prevalence of primary hypothyroidism at different levels of kidney function in Korean population. Further investigations are need to elucidate the potential causal mechanism linking hypothyroidism and CKD, adverse effects of hypothyroidism on cardiovascular risk associated with CKD, and clinical value of routine monitoring for hypothyroidism among patients with CKD. (Korean J Med 2011;81:331-333)
참고문헌 (11)
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