Abstract
Purpose
The aim of the present study was to evaluate the role of hypothyroidism as a cause of hyponatremia in a clinical model of iatrogenic acute hypothyroidism due to thyroid hormone withdrawal prior to ablative radioactive iodine (RAI) therapy after total thyroidectomy.
Methods
The study group consisted of 101 differentiated thyroid cancer (DTC) patients (77 women and 24 men). Plasma concentration of thyroid-stimulating hormone ([TSH]) and sodium ([Na+]) was evaluated before total thyroidectomy (pre[TSH] and pre[Na+]) and on the day of RAI therapy (post[TSH] and post[Na+]).
Results
The frequency of hypothyroidism-associated hyponatremia was 4 % (4/101). Pre[Na+] was significantly higher than post[Na+] (140.7 ± 1.6 vs 138.7 ± 2.3 mEq/L, p = 0.012). Moreover, a linear correlation was identified between pre[Na+] and post[Na+].
Conclusions
Iatrogenic acute hypothyroidism-related hyponatremia is uncommon. However, because of the significant reduction of [Na+] in the transition from euthyroidism to iatrogenic hypothyroidism, the value of pre[Na+] should be viewed as a parameter to be considered. Since it acts as an independent risk factor for the development of hyponatremia, patients with a pre[Na+] close to the lower limit of normal range may deserve a closer monitoring of [Na+].
Similar content being viewed by others
References
Upadhyay A, Jaber BL, Madias NE (2006) Incidence and prevalence of hyponatremia. Am J Med 119:S30–S35
Hoorn EJ, Lindemans J, Zietse R (2006) Development of severe hyponatremia in hospitalized patients: treatment-related risk factors and inadequate management. Nephrol Dial Transplant 21:70–76
Corona G, Giuliani C, Parenti G, Norello D, Verbalis JG, Forti G, Maggi M, Peri A (2013) Moderate hyponatremia is associated with increased risk of mortality: evidence from a meta-analysis. PLoS One 8:e80451
Corona G, Giuliani C, Verbalis JG, Forti G, Maggi M, Peri A (2015) Hyponatremia improvement is associated with a reduced risk of mortality: evidence from a meta-analysis. PLoS One 10:e0124105
Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G (2006) Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med 119:71.e1–71.e8
Kinsella S, Moran S, Sullivan MO, Molloy MG, Eustace JA (2010) Hyponatremia independent of osteoporosis is associated with fracture occurrence. Clin J Am Soc Nephrol 5:275–280
Hoorn EJ, Rivadeneira F, van Meurs JBJ, Ziere G, Stricker BHCh, Hofman A, Pols HAP, Zietse R, Uitterlinden AG, Zillikens MC (2011) Mild hyponatremia as a risk factor for fractures: the Rotterdam Study. J Bone Miner Res 26:1822–1828
Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, Thompson CJ (2013) Diagnosis, evaluation and treatment of hyponatremia: expert panel recommendations. Am J Med 126(10 Suppl 1):S1–42
Hammami MM, Almogbel F, Hammami S, Faifi J, Alqahtani A, Hashem W (2013) Acute severe hypothyroidism is not associated with hyponatremia even with increased water intake: a prospective study in thyroid cancer patients. BMC Endocr Disord 13:27
Al Nozha OM, Vautour L, How J (2011) Life-threatening hyponatremia following a low-iodine diet: a case report and review of all reported cases. Endocr Pract 17:e113–e117
Sun GE, Pantalone KM, Hatipoglu B (2012) Hypothyroidism as a cause of hyponatremia: fact or fiction? Endocr Pract 18:894–897
Warner MH, Holding S, Kilpatrick ES (2006) The effect of newly diagnosed hypothyroidism on serum sodium concentrations: a retrospective study. Clin Endocrinol (Oxf) 64:598–599
Marturano I, Russo M, Spadaio A, Latina A, Malandrino P, Regalbuto C (2015) Comparison of conventional l-thyroxine withdrawal and moderate hypothyroidism in preparation for whole-body 131-I scan and thyroglobulin testing. J Endocrinol Invest 38:1017–1022
Lee JE, Kim SK, Han KH, Cho MO, Yun GY, Kim KH, Choi HY, Ryu YH, Ha SK, Park HC (2014) Risk factors for developing hyponatremia in thyroid cancer patients undergoing radioactive iodine therapy. PLoS One 9:e106840
Baajafer FS, Hammami MM, Mohamed GE (1999) Prevalence and severity of hyponatremia and hypercreatininemia in short-term uncomplicated hypothyroidism. J Endocrinol Invest 22:35–39
Asiri MA, Tunio MA, Riaz K (2012) Severe symptomatic hyponatremia following low iodine diet for radioactive iodine-131 therapy in patient with papillary thyroid cancer: a case report and review of literature. J Nucl Med Radiat Ther S 6:009
Giuliani C, Cangioli M, Beck-Peccoz P, Faustini-Fustini M, Fiaccadori E, Peri A (2013) Awareness and management of hyponatremia: the italian hyponatremia survey. J Endocrinol Invest 36:693–698
Benvenuti S, Deledda C, Luciani P, Giuliani C, Fibbi B, Muratori M, Peri A (2016) Neuronal distress induced by low extracellular sodium in vitro is partially reverted by the return to normal sodium. J Endocrinol Invest 39:177–184
Acknowledgments
This study was supported by Ente Cassa di Risparmio di Firenze.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest
Ethical approval
The study has been performed in agreement with the ethical standards of the journal.
Informed consent
Informed consent was obtained from patients.
Additional information
L. Vannucci and G. Parenti have contributed equally to this manuscript.
Rights and permissions
About this article
Cite this article
Vannucci, L., Parenti, G., Simontacchi, G. et al. Hypothyroidism and hyponatremia: data from a series of patients with iatrogenic acute hypothyroidism undergoing radioactive iodine therapy after total thyroidectomy for thyroid cancer. J Endocrinol Invest 40, 49–54 (2017). https://doi.org/10.1007/s40618-016-0525-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40618-016-0525-6