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Hipotiroidizmde Ödem Mekanizmaları

Year 2019, Volume: 5 Issue: 2, 165 - 168, 01.01.2019

Abstract

Hipotiroidizm plevral, perikardiyal efüzyon veya asit yapabilir. Miksödemin başlıca bulguları sıvı retansiyonu, hiponatremi ve hidrofilik mukopolisakkaritlerin intersisyel birikimidir. Hipotiroidizm glomerüler filtrasyon oranının azalması ile beraberdir. Azalmış glomerüler filtrasyon oranı ise idrarın dilüsyonundan sorumlu kısımlara gelen su miktarını azaltarak serbest su atılımını azaltır. Hipotiroidizme bağlı seröz efüzyonların genellikle protein düzeyleri yüksek olduğu için altta yatan mekanizma muhtemelen vasküler permeabilite artışıdır. Miksödem olgularında efüzyon oluşumunun gerçek mekanizması bilinmemektedir. Vasküler Endotelyal Growth Faktör kapiller permeabiliteyi artırmaktadır ve bu faktörün düzeyleri hipotiroidizm olgularında yüksek olup tiroid hormon replasman tedavisiyle normale dönmektedir

References

  • Olsen CG. Myxedema coma in the elderly. J Am Board Fam Pract 1995;8:376-83.
  • Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet 2017; 390: 1550-62.
  • Kaptein EM, Spencer CA, Kamiel MB, Nicoloff JT. Prolonged dopamine administration and thyroid hormone economy in normal and critically ill subjects. J Clin Endocrinol Metab 1980;51:387-93.
  • Gottehrer A, Roa J, Stanford GG, Chernow B, Sahn SA. Hypothyroidism and pleural effusions. Chest 1990;98:1130-2.
  • Sahşn M, Villabona C, Rosel P, Navarro MA, Ramón JM, Gómez JM, Soler J. Water metabolism disturbances at different stages of primary thyroid failure. J Endocrinol 2001;168:435-45.
  • Chen YC, Cadnapaphornchai MA, Yang J, Summer SN, Falk S, Li C, Wang W, Schrier RW. Nonosmotic release of vasopressin and renal aquaporins in impaired urinary dilution in hypothyroidism. Am J Physiol Renal Physiol 2005;289: F672-8.
  • Panciera DL, Lefebvre HP. Effect of experimental hypothyroidism on glomerular filtration rate and plasma creatinine concentration in dogs. J Vet Intern Med 2009;23:1045-50.
  • Kwaku MP, Burman KD. Myxedema coma. J Intensive Care Med 2007;22: 224-31.
  • Franco M, Chávez E, Pérez-Méndez O. Pleiotropic effects of thyroid hormones: Learning from hypothyroidism. J Thyroid Res 2011;2011:321030.
  • Park CW, Shin YS, Ahn SJ, Kim SY, Choi EJ, Chang YS, Bang BK. Thyroxine treatment induces upregulation of renin-angiotensin-aldosterone system due to decreasing effective plasma volume in patients with primary myxoedema. Nephrol Dial Transplant 2001;16:1799-806.
  • Nakano M, Higa M, Ishikawa R, Yamazaki T, Yamamuro W. Hyponatremia with increased plasma antidiuretic hormone in a case of hypothyroidism. Intern Med 2000;39: 1075-8.
  • Liamis G, Filippatos TD, Liontos A, Elisaf MS. Management of endocrine disease: Hypothyroidism- associated hyponatremia: Mechanisms, implications and treatment. Eur J Endocrinol 2017;176: R15-R20.
  • Iwasaki, Y, Oiso Y, Yamauchi K, Takatsuki K, Kondo K, Hasegawa H, Tomita A. Osmoregulation of plasma vasopressin in myxedema. J Clin Endocrinol Metab 1990;70: 534-9.
  • Shah M, Quigley R, Baum M. Maturation of proximal straight tubule NaCl transport: Role of thyroid hormone. Am J Physiol Renal Physiol 2000; 278: F596–F602.
  • Ota K, Kimura T, Sakurada T, Shoji M, Inoue M, Sato K, Ohta M, Yamamoto T, Funyu T, Yoshida K, et al. Effects of an acute water load on plasma ANP and AVP, and renal water handling in hypothyroidism: Comparison of before and after L-thyroxine treatment. Endocr J 1994;41: 99-105.
  • Kazama I, Mori Y, Baba A, Nakajima T. Pitting type of pretibial edema in a patient with silent thyroiditis successfully treated by angiotensin ii receptor blockade. Am J Case Rep 2014;15:111-4.
  • Sahşn M, Villabona C, Rosel P, Navarro MA, Ramón JM, Gómez JM, Soler J. Water metabolism disturbances at different stages of primary thyroid failure. J Endocrinol 2001;168:435-45.
  • Musielak MC, Chae JH. Hypothyroid-induced acute compartment syndrome in all extremities. J Surg Case Rep 2016;2016 (12).
  • Atzenhoefer M, Man JH, Saad ER. Case report of hypothyroidism presenting with myxedema ascites. Journal of Clinical & Translational Endocrinology Case Reports 2017; 4: 5-7.
  • Ji JS, Chae HS, Cho YS, Kim HK, Kim SS, Kim CW, Lee CD, Lee BI, Choi H, Lee KM, Lee HK, Choi KY. Myxedema ascites: Case report and literature review. J Korean Med Sci 2006; 21: 761-4.
  • Tilton RG, Pugliese G, Chang K, Speedy A, Province MA, Kilo C, Williamson JR. Effects of hypothyroidism on vascular 125I-albumin permeation and blood flow in rats. Metabolism 1989;38: 471-8.
  • Schmid C, Brändle M, Zwimpfer C, Zapf J, Wiesli P. Effect of thyroxine replacement on creatinine, insulin- like growth factor 1, acid-labile subunit, and vascular endothelial growth factor. Clin Chem 2004;50: 228-31.
  • Hataya Y, Akamizu T, Kanamoto N, Moriyama K, Shimatsu A, Nakao K. A case of subclinical hypothyroidism developing marked pleural effusions and peripheral edema with elevated vascular endothelial growth factor. Endocr J 2007;54: 577-84.
  • Pınarbaşı B, Oflaz H, Umman B, Nişancı Y, Boztepe H, Erdoğan D, Acartürk G, Özyiğit T, Kocaman O, Alagöl F. Bir olgu nedeniyle miksödem komasına yeniden bakış. İstanbul Tıp Fakültesi Dergisi 2003; 66: 178-82.
  • Gündüz S, Aras Hİ, Geyik FD. Tek doz kas içi haloperidol ve klorpromazin uygulanması ile gelişen miksödem koması. Klinik Psikiyatri Dergisi 2014; 17: 54-8.
  • Sarı R, Ateş M, Türk M, Sevinç A, Büyükberber S, Şenol
  • M. İyi tedavi edilmemiş toksik multinodüler guatrlı bir hastada bilateral pretibiyal miksödem. Endokrinolojide Yönelişler 2000; 9: 124-6.
  • Sever M, Büyükyılmaz T, Sever F. Non-comatous myxedema attack in an elderly which precipitated by acute coronary syndrome and propranolol usage. A case report and review of the literature. Eurasian J Emerg Med 2009; 8: 50-3.

Edema Mechanisms in Hypothyroidism

Year 2019, Volume: 5 Issue: 2, 165 - 168, 01.01.2019

Abstract

Hypothyroidism can cause pleural or pericardial effusion, and ascites. The main manifestations of myxedema include retention of fluid, hyponatremia, and interstitial deposition of hydrophilic mucopolysaccharides. Hypothyroidism is associated with reduced glomerular filtration rate. Reduced glomerular filtration rate can directly decrease free water excretion by diminishing water delivery to the diluting segments. As the serous effusions due to hypothyroidism have generally high levels of protein, the underlying mechanism is probably increased vascular permeability. The precise mechanism of effusion formation in patients with myxedema is unclear. Vascular Endothelial Growth Factor also increases capillary permeability. The levels of this factor are elevated in patients with hypothyroidism and return to normal with thyroid replacement therapy

References

  • Olsen CG. Myxedema coma in the elderly. J Am Board Fam Pract 1995;8:376-83.
  • Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet 2017; 390: 1550-62.
  • Kaptein EM, Spencer CA, Kamiel MB, Nicoloff JT. Prolonged dopamine administration and thyroid hormone economy in normal and critically ill subjects. J Clin Endocrinol Metab 1980;51:387-93.
  • Gottehrer A, Roa J, Stanford GG, Chernow B, Sahn SA. Hypothyroidism and pleural effusions. Chest 1990;98:1130-2.
  • Sahşn M, Villabona C, Rosel P, Navarro MA, Ramón JM, Gómez JM, Soler J. Water metabolism disturbances at different stages of primary thyroid failure. J Endocrinol 2001;168:435-45.
  • Chen YC, Cadnapaphornchai MA, Yang J, Summer SN, Falk S, Li C, Wang W, Schrier RW. Nonosmotic release of vasopressin and renal aquaporins in impaired urinary dilution in hypothyroidism. Am J Physiol Renal Physiol 2005;289: F672-8.
  • Panciera DL, Lefebvre HP. Effect of experimental hypothyroidism on glomerular filtration rate and plasma creatinine concentration in dogs. J Vet Intern Med 2009;23:1045-50.
  • Kwaku MP, Burman KD. Myxedema coma. J Intensive Care Med 2007;22: 224-31.
  • Franco M, Chávez E, Pérez-Méndez O. Pleiotropic effects of thyroid hormones: Learning from hypothyroidism. J Thyroid Res 2011;2011:321030.
  • Park CW, Shin YS, Ahn SJ, Kim SY, Choi EJ, Chang YS, Bang BK. Thyroxine treatment induces upregulation of renin-angiotensin-aldosterone system due to decreasing effective plasma volume in patients with primary myxoedema. Nephrol Dial Transplant 2001;16:1799-806.
  • Nakano M, Higa M, Ishikawa R, Yamazaki T, Yamamuro W. Hyponatremia with increased plasma antidiuretic hormone in a case of hypothyroidism. Intern Med 2000;39: 1075-8.
  • Liamis G, Filippatos TD, Liontos A, Elisaf MS. Management of endocrine disease: Hypothyroidism- associated hyponatremia: Mechanisms, implications and treatment. Eur J Endocrinol 2017;176: R15-R20.
  • Iwasaki, Y, Oiso Y, Yamauchi K, Takatsuki K, Kondo K, Hasegawa H, Tomita A. Osmoregulation of plasma vasopressin in myxedema. J Clin Endocrinol Metab 1990;70: 534-9.
  • Shah M, Quigley R, Baum M. Maturation of proximal straight tubule NaCl transport: Role of thyroid hormone. Am J Physiol Renal Physiol 2000; 278: F596–F602.
  • Ota K, Kimura T, Sakurada T, Shoji M, Inoue M, Sato K, Ohta M, Yamamoto T, Funyu T, Yoshida K, et al. Effects of an acute water load on plasma ANP and AVP, and renal water handling in hypothyroidism: Comparison of before and after L-thyroxine treatment. Endocr J 1994;41: 99-105.
  • Kazama I, Mori Y, Baba A, Nakajima T. Pitting type of pretibial edema in a patient with silent thyroiditis successfully treated by angiotensin ii receptor blockade. Am J Case Rep 2014;15:111-4.
  • Sahşn M, Villabona C, Rosel P, Navarro MA, Ramón JM, Gómez JM, Soler J. Water metabolism disturbances at different stages of primary thyroid failure. J Endocrinol 2001;168:435-45.
  • Musielak MC, Chae JH. Hypothyroid-induced acute compartment syndrome in all extremities. J Surg Case Rep 2016;2016 (12).
  • Atzenhoefer M, Man JH, Saad ER. Case report of hypothyroidism presenting with myxedema ascites. Journal of Clinical & Translational Endocrinology Case Reports 2017; 4: 5-7.
  • Ji JS, Chae HS, Cho YS, Kim HK, Kim SS, Kim CW, Lee CD, Lee BI, Choi H, Lee KM, Lee HK, Choi KY. Myxedema ascites: Case report and literature review. J Korean Med Sci 2006; 21: 761-4.
  • Tilton RG, Pugliese G, Chang K, Speedy A, Province MA, Kilo C, Williamson JR. Effects of hypothyroidism on vascular 125I-albumin permeation and blood flow in rats. Metabolism 1989;38: 471-8.
  • Schmid C, Brändle M, Zwimpfer C, Zapf J, Wiesli P. Effect of thyroxine replacement on creatinine, insulin- like growth factor 1, acid-labile subunit, and vascular endothelial growth factor. Clin Chem 2004;50: 228-31.
  • Hataya Y, Akamizu T, Kanamoto N, Moriyama K, Shimatsu A, Nakao K. A case of subclinical hypothyroidism developing marked pleural effusions and peripheral edema with elevated vascular endothelial growth factor. Endocr J 2007;54: 577-84.
  • Pınarbaşı B, Oflaz H, Umman B, Nişancı Y, Boztepe H, Erdoğan D, Acartürk G, Özyiğit T, Kocaman O, Alagöl F. Bir olgu nedeniyle miksödem komasına yeniden bakış. İstanbul Tıp Fakültesi Dergisi 2003; 66: 178-82.
  • Gündüz S, Aras Hİ, Geyik FD. Tek doz kas içi haloperidol ve klorpromazin uygulanması ile gelişen miksödem koması. Klinik Psikiyatri Dergisi 2014; 17: 54-8.
  • Sarı R, Ateş M, Türk M, Sevinç A, Büyükberber S, Şenol
  • M. İyi tedavi edilmemiş toksik multinodüler guatrlı bir hastada bilateral pretibiyal miksödem. Endokrinolojide Yönelişler 2000; 9: 124-6.
  • Sever M, Büyükyılmaz T, Sever F. Non-comatous myxedema attack in an elderly which precipitated by acute coronary syndrome and propranolol usage. A case report and review of the literature. Eurasian J Emerg Med 2009; 8: 50-3.
There are 28 citations in total.

Details

Primary Language Turkish
Journal Section Collection
Authors

Uğur Gönlügür This is me

Tanseli Gönlügür This is me

Publication Date January 1, 2019
Published in Issue Year 2019 Volume: 5 Issue: 2

Cite

Vancouver Gönlügür U, Gönlügür T. Hipotiroidizmde Ödem Mekanizmaları. Akd Med J. 2019;5(2):165-8.