並列タイトル等放射性ヨウ素内用療法下の甲状腺ホルモン休薬中の甲状腺癌患者が高カリウム血症を引き起こす要因として、腎機能と血漿レニン活性の関与が考えられる
授与機関名Nagasaki University (長崎大学)
一般注記Objective: Hypothyroidism is not commonly considered a cause of hyperkalemia. We previously reported that hyperkalemia was observed mainly in elderly patients treated with renin-angiotensin-aldosterone system (RAS) inhibitors when levothyroxine treatment was withdrawn for the thyroidectomized patients with thyroid carcinoma to undergo radioactive iodine treatment. Here, we investigated whether acute hypothyroidism causes hyperkalemia in patients who were not treated with RAS inhibitors. We also investigated factors influencing potassium metabolism in hypothyroid patients.Methods: We conducted a single-center, prospective cohort study of 46 Japanese patients with thyroid carcinoma undergoing levothyroxine withdrawal prior to radioiodine therapy. All patients were normokalemic before levothyroxine withdrawal. Blood samples were analyzed 3 times: before, and at 3 and 4 weeks after levothyroxine withdrawal. We investigated factors that may be associated with the elevation of serum potassium levels from a euthyroid state to a hypothyroid state.Results: None of the patients developed symptomatic hyperkalemia. The mean serum potassium level was significantly higher at 4 weeks after levothyroxine withdrawal compared to baseline. The serum sodium levels, the estimated glomerular filtration rate (eGFR), and the plasma renin activity (PRA) decreased significantly as hypothyroidism advanced. In contrast, the plasma levels of adrenocorticotropic hormone, cortisol, aldosterone, and antidiuretic hormone were not changed, while serum thyroid hormone decreased. At 4 weeks after their levothyroxine withdrawal, the patients' serum potassium values were significantly correlated with the eGFR and the PRA.Conclusion: Acute hypothyroidism can cause a significant increase in the serum potassium level, which may be associated with a decreased eGFR and decreased circulating RAS.
長崎大学学位論文 学位記番号:共博(医歯薬)甲第24号 学位授与年月日:令和4年9月7日
Author: Tetsuro Niri, Ichiro Horie, Takao Ando, Hiromi Kawahara, Mayu Ueda, Mami Eto, Ayaka Sako, Yuichi Ikeuchi, Tomoe Nakao, Yomi Nakashima, Riyoko Shigeno, Ayako Ito, Aya Nozaki, Ai Haraguchi, Shoko Natsuda, Ikuko Sagara, Satoru Akazawa, Akie Kamada, Misa Imaizumi, Norio Abiru, Toshiro Usa, Atsushi Kawakami
Citation: Endocrine Practice, 26(2), pp. 197-206; 2020
identifier:Nagasaki University (長崎大学), 博士(医学) (2022-09-07)
http://hdl.handle.net/10069/41837
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