Thyroid Hormone Status during Active Phase and After Remission in Children with Nephrotic Syndrome

Abstract

Background: Protein loss in childhood nephrotic syndrome (NS) can deplete thyroid‑binding proteins, but the burden and reversibility of resulting thyroid dysfunction in South‑Asian children are poorly defined. Objectives: To quantify (i) the prevalence of biochemical thyroid abnormalities during active NS, (ii) their resolution after remission, and (iii) any association between serum albumin and thyroid indices. Methods: In a prospective observational study (July 2019–June 2020) of 80 Bangladeshi children (1–15 years) with steroid‑sensitive NS at a tertiary centre, total T3, total T4, free T4 and TSH were measured during the nephrotic phase and repeated four weeks after documented remission in 31 participants. Results: During relapse, 42.5 % exhibited thyroid dysfunction: overt hypothyroidism 15.0 %, subclinical hypothyroidism 10.0 % and low‑T3 syndrome 17.5 %. Mean TSH was mildly elevated (6.3 ± 4.3 mIU/L) while free T4 remained largely preserved. After remission, euthyroidism was restored in 93.5 % (p = 0.002); low‑T3 syndrome disappeared and only one child (3.2 %) persisted with overt hypothyroidism. Serum albumin showed no significant correlation with total T3, total T4, free T4 or TSH (r < 0.09, p > 0.48). Conclusions: Transient thyroid perturbations are common in paediatric NS but mostly resolve within four weeks of proteinuria control. Routine thyroid panels at each relapse and a single follow‑up test after remission could identify the small minority requiring endocrine referral.