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Original article

Vol. 142 No. 3738 (2012)

Thyroid function and serum electrolytes: does an association really exist?

  • Christoph Schwarz
  • Alexander Benedikt Leichtle
  • Spyridon Arampatzis
  • Georg Martin Fiedler
  • Heinz Zimmermann
  • Aristomenis Konstantinos Exadaktylos
  • Gregor Lindner
DOI
https://doi.org/10.4414/smw.2012.13669
Cite this as:
Swiss Med Wkly. 2012;142:w13669
Published
09.09.2012

Summary

BACKGROUND: Thyroid hormone is a central regulator of body functions. Disorders of thyroid function are considered to be a cause of electrolyte disorders. Only few data on the association between thyroid function and electrolyte disorders exists.

METHODS: In the present retrospective analysis data from all patients admitted to the Department of Emergency Medicine of a university hospital who had measurements of thyroid function (TSH, fT3, fT4) and electrolytes were included.

RESULTS: 9,012 patients with measurement of TSH and electrolytes were available. 86% of patients had normal, 4% suppressed and 10% elevated TSH. Serum sodium was significantly lower in patients with high TSH levels (p <0.01). There was a significant correlation between serum TSH and phosphate level (p <0.05). Phosphate levels were higher in patients with elevated TSH than in patients with normal TSH (p <0.01). Serum calcium and magnesium correlated significantly with TSH (p <0.05). fT3 levels correlated significantly with calcium (p <0.05). Hyponatraemia was present in 14% of patients with high TSH and was significantly more common than in the group with normal TSH levels of which 9% had hyponatraemia (p <0.01). Hypokalaemia was more common in the group with elevated TSH than in those with normal TSH (14 versus 11%, p = 0.016). Hyperkalaemia was more common in the group with high TSH levels (7%) than in those with normal TSH (7 vs. 4%, p <0.01).

CONCLUSION: An association between thyroid function and electrolyte disorders seems to exist, although it is probably only relevant in marked hypo-/hyperthyroidism.

References

  1. Adrogue HJ, Madias NE. Hypernatremia. N Engl J Med. 2000;342(20):1493–9.
  2. Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342(21):1581–9.
  3. Funk GC, Lindner G, Druml W, Metnitz B, Schwarz C, Bauer P, et al. Incidence and prognosis of dysnatremias present on ICU admission. Intensive Care Med. 2010;36(2):304–11.
  4. Darmon M, Timsit JF, Francais A, Nguile-Makao M, Adrie C, Cohen Y, et al. Association between hypernatraemia acquired in the ICU and mortality: a cohort study. Nephrol Dial Transplant. 2010;25(8):2510–5.
  5. Lindner G, Funk GC, Lassnigg A, Mouhieddine M, Ahmad SA, Schwarz C, et al. Intensive care-acquired hypernatremia after major cardiothoracic surgery is associated with increased mortality. Intensive Care Med. 2010;36(10):1718–23.
  6. Lindner G, Funk GC, Schwarz C, Kneidinger N, Kaider A, Schneeweiss B, et al. Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis. 2007;50(6):952–7.
  7. Hwang JC, Wang CT, Chen CA, Chen HC. Hypokalemia is associated with increased mortality rate in chronic hemodialysis patients. Blood Purif. 2011;32(4):254–61.
  8. Soliman HM, Mercan D, Lobo SS, Melot C, Vincent JL. Development of ionized hypomagnesemia is associated with higher mortality rates. Crit Care Med. 2003;31(4):1082–7.
  9. Geerse DA, Bindels AJ, Kuiper MA, Roos AN, Spronk PE, Schultz MJ. Treatment of hypophosphatemia in the intensive care unit: a review. Crit Care. 2010;14(4):R147.
  10. Mariani LH, Berns JS. The renal manifestations of thyroid disease. J Am Soc Nephrol. 2012;23(1):22–6.
  11. Iwasaki Y, Oiso Y, Yamauchi K, Takatsuki K, Kondo K, Hasegawa H, et al. Osmoregulation of plasma vasopressin in myxedema. J Clin Endocrinol Metab. 1990;70(2):534–9.
  12. Farnsworth AE, Dobyns BM. Hypercalcaemia and thyrotoxicosis. Med J Aust. 1974;2(21):782–4.
  13. Wuttke H, Kessler FJ. Clinical significance of serum magnesium concentration in thyrotoxicosis (author’s transl). Med Klin. 1976;71(6):235–8.
  14. Manoukian MA, Foote JA, Crapo LM. Clinical and metabolic features of thyrotoxic periodic paralysis in 24 episodes. Arch Intern Med. 1999;159(6):601–6.
  15. Gross P, Benzing T, Hensen J, Monig H. Practical approach to hyponatremia. Dtsch Med Wochenschr. 2011;136(34-35):1728–32.
  16. Rose BD. Clinical physiology of acid-base and electrolyte disorders. 5 ed: Mcgraw-Hill, 2001.
  17. Halperin ML, Kamel KS, Goldstein MB. Fluid, electrolyte, and acid-base physiology: a problem based approach. Philadelphia: Saunders ElSevier; 2009;4th Edition.
  18. Greenberg A, Adrogue HJ, Aggarwal N, Allon M, Anderson S, Andreoli SP. A primer on kidney diseases. ElSevier Health Science 2010;5th Edition.
  19. Croal BL, Blake AM, Johnston J, Glen AC, O’Reilly DS. Absence of relation between hyponatraemia and hypothyroidism. Lancet. 1997;350(9088):1402.
  20. Hanna FW, Scanlon MF. Hyponatraemia, hypothyroidism, and role of arginine-vasopressin. Lancet. 1997;350(9080):755–6.
  21. Schmitt R, Klussmann E, Kahl T, Ellison DH, Bachmann S. Renal expression of sodium transporters and aquaporin-2 in hypothyroid rats. Am J Physiol Renal Physiol. 2003;284(5):F1097–104.
  22. Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med. 2006;119(1):71 e1–8.
  23. Kinsella S, Moran S, Sullivan MO, Molloy MG, Eustace JA. Hyponatremia independent of osteoporosis is associated with fracture occurrence. Clin J Am Soc Nephrol. 2010;5(2):275–80.
  24. Alcalde AI, Sarasa M, Raldua D, Aramayona J, Morales R, Biber J, et al. Role of thyroid hormone in regulation of renal phosphate transport in young and aged rats. Endocrinology. 1999;140(4):1544–51.
  25. Yamashita H, Yamazaki Y, Hasegawa H, Yamashita T, Fukumoto S, Shigematsu T, et al. Fibroblast growth factor-23 in patients with Graves’ disease before and after antithyroid therapy: its important role in serum phosphate regulation. J Clin Endocrinol Metab. 2005;90(7):4211–5.
  26. Iqbal AA, Burgess EH, Gallina DL, Nanes MS, Cook CB. Hypercalcemia in hyperthyroidism: patterns of serum calcium, parathyroid hormone, and 1,25-dihydroxyvitamin D3 levels during management of thyrotoxicosis. Endocr Pract. 2003;9(6):517–21.
  27. Kumar V, Prasad R. Molecular basis of renal handling of calcium in response to thyroid hormone status of rat. Biochim Biophys Acta. 2002;1586(3):331–43.
  28. Park CW, Shin YS, Ahn SJ, Kim SY, Choi EJ, Chang YS, et al. Thyroxine treatment induces upregulation of renin-angiotensin-aldosterone system due to decreasing effective plasma volume in patients with primary myxoedema. Nephrol Dial Transplant. 2001;16(9):1799–806.

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