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Hypothalamic-pituitary thyroid abnormalities in children after renal transplantation
T Pasqualini1, J Ferraris, P Fainstein-Day
1Departamento de Pediatria, Hospital Italiano de Buenos Aires, Argentina.
Pediatric Nephrology (Berlin, Germany)
|October 1, 1996
Summary
Children with kidney transplants may experience thyroid dysfunction due to immunosuppressive drugs like glucocorticoids. This study found lower thyroid hormone levels and altered TSH response in pediatric renal transplant recipients.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Immunosuppression Therapy
Background:
- Successful renal transplantation can lead to thyroid function abnormalities in patients.
- Glucocorticoid immunosuppressants are commonly used post-transplant.
Purpose of the Study:
- To evaluate thyroid function, including serum thyroid hormone levels, thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH), and TSH circadian patterns in pediatric renal transplant recipients.
- To investigate the potential role of glucocorticoids in observed thyroid alterations.
Main Methods:
- Assessed serum total and free thyroxine (T4), basal TSH, TRH-stimulated TSH response, and nocturnal TSH surges in 18 children post-renal transplant.
- Compared findings with control subjects and analyzed the correlation between TSH response and glucocorticoid dosage (methylprednisolone and deflazacort).
Main Results:
- Patients exhibited significantly lower mean total and free T4 levels compared to controls.
- The mean TSH increment after TRH stimulation was significantly blunted in transplant recipients.
- Abnormal nocturnal TSH surges were observed in a notable proportion of patients on both methylprednisolone and deflazacort therapy, with TSH response correlating with deflazacort dose.
Conclusions:
- Pediatric renal transplant recipients may develop hypothalamic-pituitary thyroid abnormalities.
- Glucocorticoid therapy, including methylprednisolone and deflazacort, appears to play a significant role in these thyroid alterations.
- Further research is warranted to elucidate the mechanisms and clinical implications of these findings.