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Thyroid Hormone Losses in Capd

Peritoneal dialysis has been successfully used as an adjuvant for the treatment of the thyroid toxic crisis, suggesting that hormonal peritoneal clearance may be significant in this setting (1). Furthermore, thyroid dysfunc tion has been described in continuous ambulatory peritoneal dialysis (CAPD) patients by several authors (2,3) as being attributed to a uremic plasma inhibitor that blocks thyroid hormone binding (3) and to loss of thyroid hormone into the peritoneal fluid (2). Precise quantification of thyroid hormones in the peritoneal dialysate effluent, however, has been hampered by the difficulty in determining the very low levels of these compounds in the peritoneal effluent. The spontaneous reversion of hypothyroidism in one of our patients receiving CAPD when he was switched to hemodialysis prompted us to undertake a study to assess the contribution of hormonal peritoneal losses to thyroid dysfunction in a nonselected group ofCAPDpatients.