Euthyroid sick syndrome and nutritional status are correlated with hyposelenemia in hemodialysis patients.

Background: Maintenance hemodialysis (HD) patients have altered levels of thyroid hormone (TH) in euthyroid sick syndrome, along with low T3 levels and several nutritional metabolic disturbances. Selenium (Se) is an essential trace element for living organisms, which has been shown to play a major role in thyroid hormone levels and the nutritional metabolism. The aims of the present study were to assess the changes in serum levels of selenium and their correlation with disorders of the endocrine and nutritional metabolism in HD patients.

Methods: Fifty-three uremic patients with hemodialysis were evaluated; 30 healthy volunteers served as controls. Baseline serum concentrations of total triiodothyronine (TT3), free triiodothyronine (FT3), total thyroxine (TT4), and free thyroxine (FT4) were determined by radioimmunoassay (RIA). Serum levels of thyroid-stimulating hormone (TSH) and intact parathyroid hormone (iPTH) were measured by a sensitive immunoradiometric assay (IRMA). Serum selenium was analyzed using Hitachi Z- 2000 polarized Zeeman atomic absorption spectrometry. Other metabolic variables were measured in all patients and control subjects. Multiple correlation analysis was performed among variables.

Results: Higher serum triglyceride, LDL-C, ApoB and lower albumin, HDL-C levels were found in subjects with HD. Mean serum selenium concentration was significantly lower in the HD group than in the control group (p<0.01). The levels of serum TT3 and FT3 in HD patients were significantly lower than in healthy control subjects (p<0.01; p<0.05, respectively), but TT4, FT4 and TSH were not different. However, serum iPTH levels were significantly higher in patients than in controls (p<0.01). In the group of HD patients, serum selenium levels were significantly positively correlated with albumin, HDL-C, TT3 and FT3 ; and negatively correlated with triglyceride (TG), LDL-C, ApoB and iPTH. Both serum TT3 and FT3 levels were significantly positively correlated with HDL-C; and negatively correlated with TG, LDL-C and ApoB.

Conclusions: These data suggest that hyposelenemia in HD patients correlated with euthyroid sick syndrome with low T3 levels, and nutritional status with hyperlipidemia and hypoalbuminemia which might be involved in dysfunction in the endocrine and nutrition metabolism in dialysis patients.