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        "resumen" => "La lista de drogas que pueden causar alteraciones en los niveles de las hormonas tiroideas ser&#237;a interminable &#40;amiodarona&#44; metformina&#44; dopamina&#44; dobutamina&#44; propanolol&#44; carbamazepina&#44; litio&#44; glucocorticoides&#191;&#46;&#41;&#46;1&#44;2 Pero tambi&#233;n los contrastes radiol&#243;gicos3 y soluciones que contienen yodo usadas como antis&#233;ptico general y desinfectante de amplio espectro como la povidona yodada pueden causar disfunci&#243;n tiroidea4&#46; As&#237; se sabe que la povidona yodada contenida en los tapones de desconexi&#243;n de di&#225;lisis peritoneal puede ser un factor que contribuya a cambios en la funci&#243;n tiroidea&#46; Si bien&#44; la poblaci&#243;n de pacientes con mayor riesgo de verse afectada se limita a lactantes y ni&#241;os en di&#225;lisis peritoneal con peque&#241;os vol&#250;menes de llenado&#44; donde la concentraci&#243;n de yodo en el l&#237;quido de di&#225;lisis es mayor&#44; consider&#225;ndose infrecuente en poblaci&#243;n adulta5&#46;"
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Iatrogenic thyroid dysfunction in peritoneal dialysis
Disfunción tiroidea yatrogénica en diálisis peritoneal
Aránzazu Sastre Lópeza, María Victoria Mascarós Ferrera
a Servicio de Nefrología, Hospital Son LLàtzer, Palma de Mallorca, Islas Baleares, España,
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    "textoCompleto" => "To the editor&#58; The list of drugs that may cause changes in thyroid hormone levels would be endless &#40;amiodarone&#44; <br></br>metformin&#44; dopamine&#44; dobutamine&#44; propranolol&#44; carbamazepine&#44; lithium&#44; glucocorticoids&#191;&#46;&#41;&#46;1&#44;2 However&#44; <br></br>radiographic contrast agents3 and iodine-containing solutions used as general antiseptics and broad-spectrum <br></br>disinfectants&#44; such as povidone iodine&#44; may also cause thyroid dysfunction&#46; 4 Thus&#44; it is known that povidone iodine contained in the disconnect caps of peritoneal dialysis may be a factor contributing to changes in thyroid function&#46;&#46; The patient population with a higher risk is however limited to infants and children on peritoneal dialysis with small filling volumes&#44; where iodine concentration in the dialysis fluid is higher&#44; while thyroid function changes are considered uncommon in the adult population&#46;5 <br></br><br></br>The case of an elderly female patient who showed changes in TSH levels probably induced by the iodine contained <br></br>in the peritoneal dialysis cap is reported&#46; <br></br><br></br>This 70-year-old patient had been diagnosed CKD secondary to renal amyloidosis in the setting of a familial <br></br>amyloidotic polyneuropathy&#46; She also had cardiac amyloid infiltration&#44; and had been implanted a pacemaker in 2005&#46; In addition&#44; the patient had chronic diarrhea due to intestinal infiltration&#46; <br></br><br></br>Proteinuria was initially found in January 2004&#44; and progressed to levels in the nephrotic range&#46; The patient showed <br></br>a progressive renal function impairment since April 2005&#44; and was implanted a peritoneal dialysis catheter in <br></br>February 2006&#46; <br></br><br></br>Continuous ambulatory peritoneal dialysis was started on 12-04-06&#44; but a catheter leak occurred and a switch to intermittent nocturnal peritoneal dialysis with cycler and low volume &#40;1200 mL per cycle&#41; was made on 28-04-06&#46; The leak subsequently resolved&#46; <br></br><br></br>The patient had not previously shown any change in thyroid function&#44; and normal TSH levels were found before the start of dialysis&#46; Low&#44; sometimes undetectable TSH levels were seen after the low volume dialysis technique was started&#46; T3 and T4 levels were within the normal range&#44; and anti-thyroid antibodies were normal&#46; The endocrinology department was consulted&#44; and a thyroid ultrasound was performed&#44; showing a diffuse thyroid enlargement that was related to the underlying disease&#46; Fine needle puncture allowed for ruling out malignancy or an amyloid infiltrate&#46; While uncommonly&#44; infiltrative diseases such as amyloidosis may also cause thyroid dysfunction&#46;6 <br></br><br></br>The patient was asymptomatic at all times and did not require additional treatment&#46; Once the catheter leak was <br></br>resolved&#44; filling volume could be increased&#44; but continues to be low &#40;1500 mL&#41;&#44; now because of the discomfort <br></br>experienced by the patient with higher volumes&#46; Hormonal changes persist&#46; <br></br><br></br>Similar to when treatment is started with drugs altering thyroid function&#44; thyroid hormone monitoring is also recommended in patient on peritoneal dialysis with small filling volumes&#44; because the iodine contained in the disconnect cap may reach high concentrations in peritoneal fluid and pass into the blood&#44; inducing iatrogenic changes such as those occurring in the rare case reported&#46; "
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        "resumen" => "La lista de drogas que pueden causar alteraciones en los niveles de las hormonas tiroideas ser&#237;a interminable &#40;amiodarona&#44; metformina&#44; dopamina&#44; dobutamina&#44; propanolol&#44; carbamazepina&#44; litio&#44; glucocorticoides&#191;&#46;&#41;&#46;1&#44;2 Pero tambi&#233;n los contrastes radiol&#243;gicos3 y soluciones que contienen yodo usadas como antis&#233;ptico general y desinfectante de amplio espectro como la povidona yodada pueden causar disfunci&#243;n tiroidea4&#46; As&#237; se sabe que la povidona yodada contenida en los tapones de desconexi&#243;n de di&#225;lisis peritoneal puede ser un factor que contribuya a cambios en la funci&#243;n tiroidea&#46; Si bien&#44; la poblaci&#243;n de pacientes con mayor riesgo de verse afectada se limita a lactantes y ni&#241;os en di&#225;lisis peritoneal con peque&#241;os vol&#250;menes de llenado&#44; donde la concentraci&#243;n de yodo en el l&#237;quido de di&#225;lisis es mayor&#44; consider&#225;ndose infrecuente en poblaci&#243;n adulta5&#46;"
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ISSN: 20132514
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