Elevated serum creatinine levels in infants with congenital hypothyroidism: reflection of decreased renal function?

The effects of hypothyroid status on renal function have been poorly studied in children. We assessed the renal function of hypothyroid infants detected during neonatal mass screening for congenital hypothyroidism (CH). Eighty hypothyroid infants and 20 age-matched normal infants for controls were enrolled. The 80 patients, aged 1 mo, were divided into two groups based on the initial thyroid stimulating hormone (TSH) and free thyroxine (FT4) values: a mild-moderately hypothyroid (MHT) group (n = 64, 31M and 33F) and a severely hypothyroid (SHT) group (n = 16, 3M and 13F). Serum creatinine (SCr), TSH, FT4 and other chemicals were compared before and 2 mo after L-thyroxine (LT4) substitution therapy. The following results were obtained: SCr levels were significantly higher in the SHT group (33.2+/-10.0 micromol/L, p < 0.001) compared with the MHT group (20.6+/-6.4 micromol/L) and normal control group (21.0+/-4.4 micromol/L). Two months after the LT4 replacement therapy, the elevated SCr levels in the SHT group decreased by 41.3% to the level (19.5+/-6.0 micromol/L) very close to that in the MHT group (18.8+/-5.1 micromol/L). No significant differences were noted among BUN levels in the three groups. Although serum creatinine kinase levels were significantly higher in the SHT group (230.3+/-102.3 U/L, p < 0.001) than in the MHT group (121.1+/-60.8 U/L), rhabdomyolysis was not considered to be responsible for the impaired renal function.

From these results we conclude that serum creatinine levels are elevated in congenitally hypothyroid infants. This is a reversible change with thyroid hormone replacement therapy. The possibility of impaired renal functions should be kept in mind when treating hypothyroid infants.