Evaluation of thyroid disease in kidney transplantation candidates: management and follow-up

Introduction. Diagnosis of thyroid disease is fundamental in the evaluation of patientsawaiting kidney transplantation. We analyzed the incidence of thyroid disease in patientswith end-stage renal disease (ESRD) and evaluated its evolution before and after kidneytransplantation.Patients and Methods. Between January 2000 and May 2008, we evaluated 323candidates for kidney transplantation. In all patients, serum concentrations of freetriiodothyronine, free thyroxine, and thyroid-stimulating hormone were determined and aultrasonography of the neck was performed. Patients with thyroid cancer were consideredeligible for kidney transplantation after at least 2 years since treatment.Results. One-hundred-four patients with ESRD (44%) had functional or morphologicchanges in the thyroid gland. Forty-one patients (17.4%) underwent fine-needle aspirationcytology; 3 demonstrated showed papillary carcinoma; 3, follicular adenomas; 8, uncertaincytologic lesions; and 27, a nodular goiter. Seventeen patients underwent surgery. Six of 11patients with thyroid cancer underwent transplantation: two patients underwent laterocervicallymph node dissection because of local recurrence within 2 years after successful transplantation;the other 4 patients are alive with a functioning graft. Of the 184 transplant recipients, 10underwent surgery to treat thyroid disease: 8 with multinodular goiter, 1 with micropapillarycarcinoma, and 1 with follicular adenoma. All 10 patients are alive with a well-functioning graftand no signs of disease recurrence.Conclusions. Thyroid diseases are common in patients with ESRD. Early diagnosisand treatment significantly decreased morbidity and mortality in patients awaitingtransplantation.