Sodium handling in congenitally hypothyroid neonates
Sodium handling in congenitally hypothyroid neonates
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DOI：
10.1080/08035250310007259
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发表时间：
2004-01-01
期刊：
影响因子：
3.8
通讯作者：
Uchiyama, M
中科院分区：
文献类型：
--
作者：
Asami, T;Uchiyama, M
早期的观察强调了甲状腺功能低下的儿童和成人可能会发生低钠血症，但最近这一点受到了质疑。目的：通过检查筛查发现的新生儿和先天性甲状腺功能减退症(CH)婴儿的钠处理情况，探讨低钠血症是否发生在甲状腺功能低下状态。方法：对32例初筛检出的CH新生儿(男11例，女21例)和16例年龄匹配的对照组新生儿进行L-甲状腺素(LT4)替代治疗前后血清促甲状腺激素(TSH)、游离甲状腺素(FT4)、钠(Na)、肌酐(Cr)、尿钠、肌酐、部分钠排泄率(FENA)等指标的检测。结果：32例CH新生儿均未发生低钠血症。其血钠浓度(139.1+/-1.5mmo1/L，范围136~142mmo1/L，中位数139 mmoL/L)与16例对照组(139.3+/-1.3mmo1/L，137mmo1~142mmo1/L，中位数139 mmol/L)比较，差异无统计学意义。血清TSH、FT4水平与血清Na、FeNa之间无相关性。经LT4替代治疗2个月后，甲减新生儿血钠无明显变化。治疗前血钠(139.1+/-0.3mmoL/L，n=25)在LT4替代治疗2个月后无明显变化(138.9+/-0.2mmoL/L，n=25)。结论：甲减患者可发生低钠血症，但两者之间无因果关系。当在甲状腺功能低下的儿童中检测到低钠血症时，似乎与甲状腺激素缺乏没有直接关系，因此应该寻找其他可能的原因。
Early observations emphasized the possible development of hyponatraemia in hypothyroid children and adults, but recently this has been questioned. Aim: To investigate whether hyponatraemia develops in hypothyroid status by examining sodium handling in screening-detected neonates and infants with congenital hypothyroidism (CH). Methods: Serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), sodium (Na), creatinine (Cr), urinary Na, Cr, fractional sodium excretion rate (FENa) and other chemicals were measured before and after L-thyroxine (LT4) replacement therapy in 32 screening-detected CH neonates (11M, 21F) and 16 age-matched control neonates. Results: No cases of hyponatraemia were found in the 32 CH neonates. Their serum Na concentrations (139.1+/-1.5 mmol/L, ranging from 136 to 142 mmol/L, median 139 mmol/L) were not statistically different from those of 16 control neonates (139.3+/-1.3 mmol/L, ranging from 137 to 142 mmol/L, median 139 mmol/L,). No correlation was found between serum levels of TSH and FT4 and serum Na or FENa. No significant changes were found in serum Na concentrations in hypothyroid neonates two months after LT4 replacement therapy. The serum Na concentration (139.1+/-0.3 mmol/L, n=25) before treatment did not change statistically (138.9+/-0.2 mmol/L, n=25) two months after LT4 replacement therapy.Conclusion: As seen in various earlier reports, hyponatraemia can occur in hypothyroid patients, but no causal relationship exists between them. When hyponatraemia is detected in hypothyroid children, it does not seem to be directly related to lack of thyroid hormones and therefore other possible causes should be sought.