PMID- 11522861
OWN - NLM
STAT- MEDLINE
DCOM- 20011204
LR  - 20220331
IS  - 0931-0509 (Print)
IS  - 0931-0509 (Linking)
VI  - 16
IP  - 9
DP  - 2001 Sep
TI  - Thyroxine treatment induces upregulation of renin-angiotensin-aldosterone system 
      due to decreasing effective plasma volume in patients with primary myxoedema.
PG  - 1799-806
AB  - BACKGROUND: In experimental animals and humans, hypothyroidism is associated with 
      fluid retention and generalized oedema, increased antidiuretic hormone (ADH), 
      decreased atrial natriuretic hormone (ANH), and decreased 
      renin-angiotensin-aldosterone system (RAAS), which subsequently can be corrected 
      by thyroid hormone replacement. The purpose of this study was to determine the 
      effect of thyroxine therapy on RAAS and neurohormones affecting water and 
      electrolyte metabolism and the reason for these changes in patients with primary 
      myxoedema. METHODS: We measured changes in the plasma renin activity (PRA), serum 
      aldosterone (Aldo), ADH, ANH levels, serum and 24 h urinary electrolytes and 
      osmolalities, and cardiac function in 22 female patients with primary myxoedema 
      before and after correction of hypothyroidism. We also evaluated age-, sex-, and 
      BMI-matched 15 healthy control subjects (Cont). RESULTS: It took an average of 
      4.3 months (range, 3-9 months) to normalize thyroid function. The mean reductions 
      of body weight and estimated plasma volume were 1.8+/-1.0 kg (P=0.002) and 8.5% 
      (P<0.001), respectively. In addition, serum Na+ and osmolality and the 
      haematocrit were significantly elevated after correction of hypothyroidism 
      (P<0.01 and P<0.001, respectively). Increased F(E)Na and C(OSM) (P<0.05) levels 
      in patients with hypothyroidism (Ho) compared with those in Cont did not change 
      after thyroxine therapy (Eu). However, C(H(2)O), U(E)K, F(E)K, and TTKG levels as 
      well as creatinine clearance (Ccr) were markedly increased in Eu compared with Ho 
      and Cont (P<0.01, respectively). Increased plasma ADH concentration and decreased 
      plasma ANH concentration were normalized compared to Cont after thyroxine therapy 
      (P<0.001 and P<0.01, respectively). Low PRA and serum Aldo concentration in Ho 
      were significantly increased in Eu (P<0.001 and P<0.01, respectively). In 
      addition, increased left ventricular mass index and decreased cardiac output in 
      Ho were normalized compared to Cont after thyroxine therapy (P<0.01, 
      respectively) CONCLUSIONS: These findings suggest that the exaggerated 
      upregulation of RAAS after correction of hypothyroidism in patients with primary 
      myxoedema is associated with an increase in Ccr and a decrease in plasma volume 
      resulting from water diuresis, natriuresis, osmotic diuresis and inappropriate 
      changes in plasma ADH and ANH levels. The improved renal function coincided with 
      an amelioration of cardiac function. These changes seem to be an adaptive 
      response for preventing excessive plasma volume and weight loss after thyroxine 
      therapy.
FAU - Park, C W
AU  - Park CW
AD  - Division of Nephrology, Department of Internal Medicine, College of Medicine, The 
      Catholic University of Korea, #62 Yoido-Dong, Youngdungpo-Ku, Seoul 150-713, 
      Korea.
FAU - Shin, Y S
AU  - Shin YS
FAU - Ahn, S J
AU  - Ahn SJ
FAU - Kim, S Y
AU  - Kim SY
FAU - Choi, E J
AU  - Choi EJ
FAU - Chang, Y S
AU  - Chang YS
FAU - Bang, B K
AU  - Bang BK
LA  - eng
PT  - Journal Article
PL  - England
TA  - Nephrol Dial Transplant
JT  - Nephrology, dialysis, transplantation : official publication of the European 
      Dialysis and Transplant Association - European Renal Association
JID - 8706402
RN  - 0 (Neurotransmitter Agents)
RN  - 0 (Thyroid Hormones)
RN  - Q51BO43MG4 (Thyroxine)
SB  - IM
MH  - Adult
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Kidney/drug effects/physiopathology
MH  - Myxedema/*drug therapy/*physiopathology
MH  - Neurotransmitter Agents/blood
MH  - *Plasma Volume
MH  - Renin-Angiotensin System/*drug effects
MH  - Thyroid Hormones/blood
MH  - Thyroxine/*therapeutic use
MH  - Up-Regulation
EDAT- 2001/08/28 10:00
MHDA- 2002/01/05 10:01
CRDT- 2001/08/28 10:00
PHST- 2001/08/28 10:00 [pubmed]
PHST- 2002/01/05 10:01 [medline]
PHST- 2001/08/28 10:00 [entrez]
AID - 10.1093/ndt/16.9.1799 [doi]
PST - ppublish
SO  - Nephrol Dial Transplant. 2001 Sep;16(9):1799-806. doi: 10.1093/ndt/16.9.1799.