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Thyroid Dysfunction in Uremia: Evidence for Thyroid and Hypophyseal Abnormalities

GERMAN RAMIREZ, M.D.; WILLIAM O'NEILL Jr., M.D.; WILLIAM JUBIZ, M.D., F.A.C.P.; and H. ALLAN BLOOMER, M.D., F.A.C.P.
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Grant support: in part by Contract H01-AM-3-2223 from the Artificial Kidney Program of the National Institute of Arthritis, Metabolic and Digestive Diseases; U.S. Public Health Services Research Grant RR-64, from the Division of Research Resources; and the Veterans Administration.

▸Requests for reprints should be addressed to German Ramirez, M.D., Chief; Hemodialysis (11H), Veterans Administration Hospital, 500 Foothill Drive; Salt Lake City, UT 84113.


Salt Lake City, Utah


Ann Intern Med. 1976;84(6):672-676. doi:10.7326/0003-4819-84-6-672
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Disturbances in thyroid function and a high prevalence of goiter develop in patients on chronic hemodialysis. This study shows that in patients on dialysis, mean serum thyroxine and triiodothyronine levels are lower than normal. Patients with chronic renal failure not on dialysis, have mean serum thyroxine levels similar to normal subjects and low mean serum triiodothyronine levels. However, both serum thyroxine and triiodothyronine concentrations decrease as the renal failure worsens. In addition, both groups of patients with renal failure have a decreased serum thyroxine response to exogenous thyrotrophin and a diminished serum thyrotrophin response to thyrotrophin-releasing hormone. These data suggest the presence of an intrathyroidal and an hypophyseal defect in uremic patients. Although serum iodide concentrations are elevated, there is no correlation between the level of serum iodide and the degree of renal failure. Therefore, we have no direct evidence that iodide excess is responsible for the abnormalities observed.

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