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Is There Relationship Between Thyroid Volume, Hyperparathyroidism and Cardiovascular Risk Factors in Patients Under Hemodialysis?.

Background: Thyroid dysfunction and hyperparathyroidism are common in with chronic kidney disease (CKD) and under dialysis. It is known that they increase the risk of cardiovascular (CV) diseases in this population. Objectives: In this study, we aimed to investigate the relationship between thyroid volume, hyperparathyroidism (HPTH), atherogenic index of plasma (AIP), carotis intimamedia thickness (CIMT) and uric acid (UA) in hemodialysis (HD) patients. Arch Nephrol Urol 2020; 3 (2): 017-026 DOI: 10.26502/anu.2644-2833016 Archives of Nephrology and Urology 18 Methodology: Hemodialysis patients without thyroid dysfunction were divided into three groups as; low (<13.6 pg/mL), target (13.6-61.2 pg/mL) and high (> 61.2 pg/mL) parathyroid hormone (PTH) levels continuing for at least 6 months. Routine laboratory tests, PTH, lipid profile, high sensitive CRP (hs-CRP), TSH, T4, T3, glucose, UA, insulin, C-peptide, AIP, thyroid ultrasonography performed and CIMT were evaluated and recorded. Results: Total thyroid volume was 21.64 ± 1.83, 15.01 ± 1.60, 19.52 ± 1.41 mL respectively in males, females and whole group. Total thyroid volume, AIP, hs-CRP, UA, bilateral CIMT were all lower in low PTH group in comparison with other groups, but statistically significant only for hs-CRP levels. There was positive correlation between total thyroid volume and bilateral CIMT, hs-CRP; and negative correlation between Kt/V and thyroid volume. Conclusion: In HD patients; thyroid volume may be an indicator of CV risk in harmony with other risk factors.


Introduction
Chronic kidney disease (CKD) is a worldwide public health problem with poor results and increasing incidence. It progresses with reduced glomerular filtration rate (GFR) and affects 10-20% of adults worldwide [1]. In patients In this study, it was aimed to investigate the relationship between thyroid gland volume, HPTH and atherogenic index of plasma (AIP) and carotis intima-media thickness (CIMT) in the patient population undergoing RRT, and to evaluate the relation between these parameters, each of which is an independent cardiovascular (CV) risk factor.

Methodology
according to low uric acid and high uric acid levels and low Kt/V and high Kt/V ratios. In addition to the routine laboratory examinations of the patients in the study, laboratory parameters such as parathyroid hormone (PTH),   lipid profile, high sensitive CRP, TSH, T4, T3, glucose, UA, insulin, C-peptide, and AIP and also thyroid ultrasonography performed simultaneously by the same Endocrinologist and carotid intima media thickness, which is an indicator of atherosclerosis, was evaluated and recorded.

Statistic analysis
The data was analyzed using SPSS for Windows version

Results
In our study group; mean age of males and females were 58.94 ± 2.84 and 57.5 ± 4.43 respectively (Table 1). Total thyroid volume was 21.64 ± 1.83 mL in males, 15.01 ± 1.60 mL in females and overall thyroid volume was 19.52 ± 1.41 mL (Table 2). When groups were seperated as low (< 13.6 pg/mL), target (13.6-61.2 pg/mL) and high (> 61.2 pg/mL) PTH levels continuing for at least 6 months; total thyroid volume, AIP, hs-CRP, uric acid, bilateral CIMT were all lower in low PTH group in comparison with other groups, but statistically significant only for hs-CRP levels ( Table   3). When groups were separated as low (<7 mg/dL) and high (> 7 mg/dL) UA levels continuing for at least 3 months; hs-CRP levels were also high in low UA group, however without stastical significance (Table 4). When groups were seperated as low (<1.2) and high (> 1.2) Kt/V levels for at least 1 year; total thyroid volume (p<0.001), bilateral CIMT (p<0.001) and total cholesterol levels (p=0.002) were all higher in low Kt/V group than high group (Table 5). Also, there was positive correlation between total throid volume and left CIMT, right CIMT, hs-CRP; and negative correlation between Kt/V and thyroid volume (Table 6, Figure 1).

Archives of Nephrology and Urology 20
Mean ± SEM; (Body surface area (BSA) was calculated using the Dubois formula)     In studies conducted in the general population, HPTH has been shown to be associated with CV disease [14]. In CKD patients, some studies have shown that there is a higher risk of death due to CVD with increased PTH levels [15], while others have reported that low PTH is associated with a greater risk for CVD [16].

Conclusions
In HD patients; thyroid volume, hyperparathyroidism, uric acid and atherogenic index of plasma may be an indicator of CV risk in harmony with other risk factors. Clinicians should evaluate these parameters during their clinical practices.

Ethics and Consent
Institutional Review board allowed for the project, and informed consent was taken from each participant. 12.