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The diurnal change of thyroid-stimulating hormone and the effect of this change on thyroid functions in patients with chronic kidney disease

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Abstract

Purpose

Thyroid-stimulating hormone (TSH) has a pulsatile and circadian rhythm in healthy individuals. We aimed to evaluate the diurnal changes of free thyroid hormones and serum TSH levels in patients with end-stage renal failure (ESRF) whose thyroidal functions are at normal ranges.

Methods

Thirty hemodialysis patients with chronic renal failure and without a known thyroidal disease who are over 18 and 35 healthy individuals were included. The serum TSH, free T3, and free T4 levels were examined among the patient and control group which were taken at 8:00 a.m., 4:00 p.m., and 0:00 a.m.

Results

Twenty-two (73.3%) patients were male, and the mean age of the patient group was 64 (sd = 14.45 years). Seventeen (48.6%) of the control group were female, and the mean age was 31.9 (sd = 6.4 years). Serum free T3 levels, measured at three different time points (8:00 a.m., 4:00 p.m., and 0:00 a.m.), were significantly lower in the patient group than in the control group and serum free T4 levels were measured at three different time points (8:00 am, 4:00 p.m., and 0:00 a.m.) were significantly higher in the patient group than in the control group. Serum TSH levels were higher in the patient group than in the control group at 08:00, and were lower at 24:00 (p < 0.001). The nocturnal increase of serum TSH level under 0.525 suggested diurnal rhythm disruption with 83% sensitivity and 87% specificity.

Conclusion

The nocturnal serum TSH increase is not seen in ESRF patients who did not have a thyroid disease. We think that not observing a nocturnal TSH increase could be an early indication of the sick euthyroid syndrome.

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Authors and Affiliations

  1. Batman Training and Research Hospital, Batman, Turkey

    Hüseyin Soylu

  2. Ankara Yıldırım Beyazıt University, Medicine Faculty, Ankara, Turkey

    Reyhan Ersoy, Merve Ergin Tunçay, Bekir Çakır & Bülent Yalçın

  3. Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Department of Intensive Care, Istanbul, Turkey

    Pelin Bal Keske

  4. Aksaray University, Medicine Faculty Department of Biostatistics, Aksaray, Turkey

    Can Ateş

Authors
  1. Hüseyin Soylu
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  2. Reyhan Ersoy
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Contributions

All authors contributed to the study conception and design. All authors read and approved the final manuscript.

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Correspondence to Hüseyin Soylu.

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The authors declare no competing interests.

Ethics approval

Before running the research, we received ethics committee approval from Ankara Atatürk Education and Research Hospital Ethics Committee (No:15). Study code were 25.06.2012-25. All people in the patient and control group filled informed consent form.

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Soylu, H., Ersoy, R., Keske, P.B. et al. The diurnal change of thyroid-stimulating hormone and the effect of this change on thyroid functions in patients with chronic kidney disease. Endocrine 82, 580–585 (2023). https://doi.org/10.1007/s12020-023-03446-z

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  • DOI: https://doi.org/10.1007/s12020-023-03446-z

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