A study on relationship between the abnormal thyroid hormone and traditional chinese medical syndrome in patients with chronic kidney disease

Objective By analyzing serum thyroid hormone in patients with chronic kidney disease (CKD), to discuss the relationship between hypothyroidism and normal hypothyroidism and syndrome differentiation of CKD.Methods The general data of patients and syndrome differentiation of traditional Chinese medicine were recorded, and the serum thyroid hormone levels were determined. The abnormal thyroid hormone was analyzed in patients with CKD and the relationship between syndrome differentiation of traditional Chinese medicine and abnormal thyroid hormone was evaluated.Results 220 CKD patients with stage 1-5 were enrolled in this study. There were 130 males and 90 females with the average age of (35.8±13.9) years old. There are 72 cases of primary nephrotic syndrome, and 10 cases of secondary nephrotic syndrome. Of 70 cases of nephritis syndrome, there were 28 cases of lupus nephritis. Of 68 cases of chronic renal failure, 49 patients received renal biopsy. Pathologically, there were 24 cases of IgA nephropathy, 6 cases of segmental glomerular sclerosis in the foci segment, 9 cases of atypical film stasis, 8 cases of membranous nephropathy, and 2 cases of mild mesangial hyperplasia. Twenty-six cases had abnormal thyroid function (11.8%), in which the serum T3 of 18 cases (69.2%) was decreased. The serum T3 and T4 levels in 4 cases (15.4%) were decreased. In one case (3.9%), the serum T3 and thyroid stimulating hormone (TSH) levels were increased. The serum T4 levels in 3 cases (11.5%) were decreased. The serum T3 levels in the patients with CKD 5 were significantly lower than in those with CKD 1-2 and CKD 3-4 (P<0.05). There was no significant difference in serum T4 and serum TSH levels among three groups (P>0.05). Through syndrome differentiation of traditional Chinese medicine in CKD patients with abnormal thyroid hormone, it was found that the patients with decreased T2, and normal T4 and TSH showed the main manifestation of spleen kidney Yang deficiency type, and the secondary manifestation of Qi deficiency type in spleen and kidney. The patients with decreased T3 and T4 with/without increase of TSH showed the main manifestation of deficiency type of both yin and yang, and the secondary manifestation of Qi Yin deficiency and spleen kidney Yang deficiency type.Conclusions In CKD patients, serum T3 level was decreased, T4 level was normal or decreased, and TSH level was in the normal range. There is a certain relationship between the thyroid hormone level and syndrome differentiation of traditional Chinese medicine. For CKD patients combined with non-thyroid disease syndrome, traditional Chinese medicine dialectical treatment with warming Yang, tonifying spleen and replenishing qi as the main therapeutic principles can treat subclinical hypothyroidism and normal thyroid sick syndrome.