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    "textoCompleto" => "To the editor We report a new case of glomerular disease associated to thyroid disease&#44; after the one recently published in this same journal&#46;1 <br></br><br></br>A 60-year-old&#160; female patient with an unremarkable&#160; history&#160; consulted&#160; her&#160; general&#160; practitioner&#160; complaining&#160; of&#160; fatigue&#44;&#160; depressive&#160; symptoms&#44;&#160; and&#160; mild ankle edema in the previous month&#46; Laboratory&#160; test&#160; results&#160; included&#160; serum&#160; albumin levels of 1&#46;9 g&#47;dL&#44; cholesterol levels of 338 mg&#47;dL&#44;&#160; creatinine&#160; levels of 0&#46;9&#160; mg&#47;dL&#44;&#160; proteinuria&#160; of&#160; 5&#46;8&#160; g&#47;24&#160; h&#44; TSH 9&#46;9 &#956;IU&#47;mL &#40;normal 0&#46;4-4&#41;&#44; antiperoxidase antibodies 714 IU&#47;mL &#40; normal &#60;&#160; 60&#41;&#46;&#160; Treatment was&#160; started&#160; with&#160; levothyroxin 50 mcg&#47;24 h and atorvastatin 20 mg&#47;24 h&#44; and patient was finally referred to hospital six months later for completing&#160; work-up&#46;&#160; The&#160; only&#160; significant findings in physical examination were signs of venous&#160; insufficiency&#160; in&#160; the lower&#160; limbs with no noticeable ankle edema&#46; At the time&#44; the patient had normal renal function with the following laboratory test results&#58; albumin 2&#46;6 mg&#47;dL&#44; cholesterol&#160; 239 mg&#47;dL&#44;&#160; proteinuria&#160; 3&#46;4 g&#47;24 h&#44; TSH 10&#46;9 &#956;IU&#47;mL&#44; free T4 0&#46;98 ng&#47;dL &#40;normal 0&#46;6-1&#46;8&#41;&#44; antiperoxidase Ab &#62; 1300 IU&#47;mL&#44; antithyroglobulin Ab &#62; 500 IU&#47;mL &#40;normal&#60;60&#41;&#46; Autoimmune study was normal&#44; and tumor markers and viral serologic tests &#40;HBV&#44; HCV&#41; were&#160; negative&#46; Colonoscopy&#160; and mammography were normal&#46; A percutaneous renal&#160; biopsy showed&#160; lesions&#160; consistent with a stage II membranous kidney disease&#46; Based on diagnosis of autoimmune&#160; phyroiditis&#44;&#160; subclinical&#160; hypothyroidism&#44; and nephrotic syndrome due to membranous nephropathy&#44; levothyroxin was discontinued because&#160; of&#160; normal T4&#160; levels and treatment was started with lisinopril 20 mg&#44;&#160; candesartan&#160; 16 mg&#44;&#160; and&#160; sustained&#160; release&#160; fluvastatin&#160; 80&#160; mg&#46;&#160; Six months&#160; later&#44;&#160; the&#160; patient&#160; remained&#160; in&#160; a good clinical condition&#44; with no edema&#44; and laboratory tests showed a partial remission of nephrotic syndrome with proteinuria of 1&#46;6 g&#47;24 h&#44; serum albumin 4&#46;1 g&#47;dL&#44; cholesterol 177 mg&#47;dL&#44; as well as a virtually normal thyroid function &#40;TSH 4&#46;5 &#956;IU&#47;mL&#44; T4 1 ng&#47;dL&#41;&#46; <br></br><br></br>Association of thyroid disease and glomerular diseases is known&#44; though few cases have been reported&#46; Particular mention should be made of association of Graves disease and membranous nephropathy&#46;2 Autoimmune thyroiditis has also been reported to be associated to&#160; this same nephropathy&#44;3&#44;4 and also&#160; to IgA nephropathy&#44;5&#44;6 minimal change disease&#44;1&#44;7&#44;8 and&#160; membranoproliferative glomerulonephritis&#46;9&#44;10 <br></br><br></br>As reported by some authors&#44;1&#44;10&#44;11 simultaneous occurrence of thyroid and glomerular disease could be explained by the existence of an autoimmune pathogenesis common to both conditions&#44; and incidence could be higher than suspected&#44; with proteinuria being found in a high proportion of patients with autoimmune thyroiditis and Graves disease&#46; In our case&#44; thyroiditis was diagnosed&#160; based&#160; on positive antithyroid antibodies&#44; and its clinical manifestation was a subclinical hypothyroidism&#46; The parallelism seen between remission of nephrotic syndrome and TSH normalization should be noted&#46; Use of levothyroxin&#44; corticosteroids&#44; or other immunosuppressants&#44; that&#160; were&#160; administered&#160; in&#160; some&#160; previously&#160; reported cases&#44;3&#44;6-10 was&#160; not&#160; required&#46;&#160; The&#160; need for&#160; investigating&#160; thyroid&#160; function&#160; in cases of apparently idiopathic nephrotic syndrome should be stressed&#46; "
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Autoimmune thyroiditis, subclinical hypothyroidism, and nephrotic syndrome caused by menbranous nephropathy
Tiroiditis autoinmune, hipotiroidismo subclínico y síndrome nefrótico por nefropatía membranosa
José María Peña Portaa, Javier González Igualb, Carmen Vicente de Vera Floristánc
a Unidad de Nefrología, Hospital de Barbastro, Barbastro, Huesca, España,
b Sección de Medicina Interna, Hospital de Barbastro, Barbastro, Huesca, España,
c Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lérida, Lérida, España,
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    "textoCompleto" => "To the editor We report a new case of glomerular disease associated to thyroid disease&#44; after the one recently published in this same journal&#46;1 <br></br><br></br>A 60-year-old&#160; female patient with an unremarkable&#160; history&#160; consulted&#160; her&#160; general&#160; practitioner&#160; complaining&#160; of&#160; fatigue&#44;&#160; depressive&#160; symptoms&#44;&#160; and&#160; mild ankle edema in the previous month&#46; Laboratory&#160; test&#160; results&#160; included&#160; serum&#160; albumin levels of 1&#46;9 g&#47;dL&#44; cholesterol levels of 338 mg&#47;dL&#44;&#160; creatinine&#160; levels of 0&#46;9&#160; mg&#47;dL&#44;&#160; proteinuria&#160; of&#160; 5&#46;8&#160; g&#47;24&#160; h&#44; TSH 9&#46;9 &#956;IU&#47;mL &#40;normal 0&#46;4-4&#41;&#44; antiperoxidase antibodies 714 IU&#47;mL &#40; normal &#60;&#160; 60&#41;&#46;&#160; Treatment was&#160; started&#160; with&#160; levothyroxin 50 mcg&#47;24 h and atorvastatin 20 mg&#47;24 h&#44; and patient was finally referred to hospital six months later for completing&#160; work-up&#46;&#160; The&#160; only&#160; significant findings in physical examination were signs of venous&#160; insufficiency&#160; in&#160; the lower&#160; limbs with no noticeable ankle edema&#46; At the time&#44; the patient had normal renal function with the following laboratory test results&#58; albumin 2&#46;6 mg&#47;dL&#44; cholesterol&#160; 239 mg&#47;dL&#44;&#160; proteinuria&#160; 3&#46;4 g&#47;24 h&#44; TSH 10&#46;9 &#956;IU&#47;mL&#44; free T4 0&#46;98 ng&#47;dL &#40;normal 0&#46;6-1&#46;8&#41;&#44; antiperoxidase Ab &#62; 1300 IU&#47;mL&#44; antithyroglobulin Ab &#62; 500 IU&#47;mL &#40;normal&#60;60&#41;&#46; Autoimmune study was normal&#44; and tumor markers and viral serologic tests &#40;HBV&#44; HCV&#41; were&#160; negative&#46; Colonoscopy&#160; and mammography were normal&#46; A percutaneous renal&#160; biopsy showed&#160; lesions&#160; consistent with a stage II membranous kidney disease&#46; Based on diagnosis of autoimmune&#160; phyroiditis&#44;&#160; subclinical&#160; hypothyroidism&#44; and nephrotic syndrome due to membranous nephropathy&#44; levothyroxin was discontinued because&#160; of&#160; normal T4&#160; levels and treatment was started with lisinopril 20 mg&#44;&#160; candesartan&#160; 16 mg&#44;&#160; and&#160; sustained&#160; release&#160; fluvastatin&#160; 80&#160; mg&#46;&#160; Six months&#160; later&#44;&#160; the&#160; patient&#160; remained&#160; in&#160; a good clinical condition&#44; with no edema&#44; and laboratory tests showed a partial remission of nephrotic syndrome with proteinuria of 1&#46;6 g&#47;24 h&#44; serum albumin 4&#46;1 g&#47;dL&#44; cholesterol 177 mg&#47;dL&#44; as well as a virtually normal thyroid function &#40;TSH 4&#46;5 &#956;IU&#47;mL&#44; T4 1 ng&#47;dL&#41;&#46; <br></br><br></br>Association of thyroid disease and glomerular diseases is known&#44; though few cases have been reported&#46; Particular mention should be made of association of Graves disease and membranous nephropathy&#46;2 Autoimmune thyroiditis has also been reported to be associated to&#160; this same nephropathy&#44;3&#44;4 and also&#160; to IgA nephropathy&#44;5&#44;6 minimal change disease&#44;1&#44;7&#44;8 and&#160; membranoproliferative glomerulonephritis&#46;9&#44;10 <br></br><br></br>As reported by some authors&#44;1&#44;10&#44;11 simultaneous occurrence of thyroid and glomerular disease could be explained by the existence of an autoimmune pathogenesis common to both conditions&#44; and incidence could be higher than suspected&#44; with proteinuria being found in a high proportion of patients with autoimmune thyroiditis and Graves disease&#46; In our case&#44; thyroiditis was diagnosed&#160; based&#160; on positive antithyroid antibodies&#44; and its clinical manifestation was a subclinical hypothyroidism&#46; The parallelism seen between remission of nephrotic syndrome and TSH normalization should be noted&#46; Use of levothyroxin&#44; corticosteroids&#44; or other immunosuppressants&#44; that&#160; were&#160; administered&#160; in&#160; some&#160; previously&#160; reported cases&#44;3&#44;6-10 was&#160; not&#160; required&#46;&#160; The&#160; need for&#160; investigating&#160; thyroid&#160; function&#160; in cases of apparently idiopathic nephrotic syndrome should be stressed&#46; "
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Article information
ISSN: 20132514
Original language: English
DOI:
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