Evluation of Thyroid Functions in Hemodialysis Childern in Sohag University Hospital

Study Overview
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Brief Summary
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Thyroid gland and its hormones play an important role in organ development and the homeostatic control of many physiological mechanisms such as body growth and energy expenditure. The two main thyroid hormones are triiodothyronine (T3) and thyroxine (T4) affect renal development and metabolism so any impairment in thyroid functions lead to or aggravate kidney diseases. On the other hand, kidneys play an important role in the thyroid metabolism as it normally contributes to the clearance of iodide, primarily by glomerular filtration. Among patients with renal failure, there is diminished iodide excretion and an increase in plasma inorganic iodide, which results in increased uptake of the iodide by the thyroid gland. Increases in total body inorganic iodide can potentially block thyroid hormone production (the Wolff-Chaik off effect). Such a change may explain the slightly higher frequency of goiter and hypothyroidism in patients with chronic kidney diseases. The kidneys affect the hypothalamic pituitary-thyroid axis, so any impairment in kidney functions leads to disturbed thyroid physiology. All levels of the hypothalamic-pituitary-thyroid axis may be involved, including alterations in hormone production, distribution, and excretion. End stage renal disease (ESRD) and hemodialysis (HD) affect the levels of all thyroid hormones. The earliest and the most common thyroid function abnormality in patients with ESRD on HD is low T3 level (especially total T3 than free T3). This is called 'low T3 syndrome. The prevalence of subclinical hypothyroidism has been reported to be much higher in patients with ESRD on HD than in the general population. Due to similarity of signs and symptoms, sometimes it is difficult to identify subjects with ESRD also has hypothyroidism; therefore, different studies have been carried out to establish the incidence of these conditions.

Official Title
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Evalution of Thyroid Functions in Hemodialysis Children in Sohag University Hospital

Conditions
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Chronic Renal Failure

Intervention / Treatment
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* Diagnostic Test: thyroid function tests
* Diagnostic Test: complete blood count
* Diagnostic Test: serum creatinine
* Diagnostic Test: blood urea
* Diagnostic Test: serum electrolyte
* Diagnostic Test: serum calcium
* Diagnostic Test: serum phosphorus
* Diagnostic Test: parathyroid hormone level
* Diagnostic Test: liver function test
* Diagnostic Test: arterial blood gases
* Diagnostic Test: complete urine analysis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children started hemodialysis for end stage renal disease at age of 2 to 16 years will be included in the study. Exclusion Criteria: Patients with known thyroid disease. Patients with a history of autoimmune disease .

Ages Eligible for Study
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Minimum Age: 2 Years
Maximum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: pediatric group<br> | Diagnostic Test: thyroid function tests<br>* Thyroid function tests:thyroid stimulating hormone (TSH), total thyroxine (T4), free thyroxine (FT4), total triiodothyronine (T3), and free triiodothyronine (FT3)<br>Diagnostic Test: complete blood count<br>* complete blood count<br>Diagnostic Test: serum creatinine<br>* serum creatinine<br>Diagnostic Test: blood urea<br>* blood urea<br>Diagnostic Test: serum electrolyte<br>* serum electrolyte<br>Diagnostic Test: serum calcium<br>* serum calcium<br>Diagnostic Test: serum phosphorus<br>* serum phosphorus<br>Diagnostic Test: parathyroid hormone level<br>* parathyroid hormone level<br>Diagnostic Test: liver function test<br>* ALT_AST_Total biliruin_total protein _serum albumin<br>Diagnostic Test: arterial blood gases<br>* PH_PCO2_PO2_HCO3_base deficit<br>Diagnostic Test: complete urine analysis<br>* complete urine analysis<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Detection of thyroid function in hemodialysis childern | Detection of decrease thyroid function(T3_T4_TSH) in hemodialysis childern Detection of increase thyroid function(T3_T4_TSH) in hemodialysis childern | 6 months |