Background: Hypothyroidism, characterised by low/normal free thyroxine (FT4) and free triiodothyronine
(FT3) with elevated thyroid-stimulating hormone (TSH), is a well-known complication of
nephrotic syndrome (NS). This is a common feature of primary and secondary glomerular diseases and
comprises loss of protein in the urine and increased urinary excretion of thyroid hormones and thyroxine-
binding globulin. With a normal thyroid reserve, this scenario is associated with the development of
subclinical hypothyroidism, with a slight increase in TSH and normal free fractions. However, with a
low thyroid reserve the transition toward overt hypothyroidism is almost inevitable, affecting morbidity
and mortality. As T4 replacement is a cheap and well-established treatment to achieve a stable hormone
status in different types of thyroid deficiency, it is essential to recognise and appropriately treat this
Conclusion: In this article we summarise the evidence on this nephro-endocrine disorder in humans and
focus on diagnostic and therapeutic strategies.
Keywords: Nephrotic syndrome, hypothyroidism, glomerulonephritis, thyroid hormones, replacement, treatment.
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