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The thyroid status was studied in 19 uremic patients (11 on HD and 8 on CAPD) and in a group of 17 healthy adult patients. In uremic patients T3and T4were significantly reduced (p < 0.001) and rT3was increased (p < 0.001). The time course TSH response to TRH showed a lower peak response (in 5 patients it did not exceed 5 μU/ml) which on turn was also delayed (the peak was observed at 60 minutes in 63% of them). TSH concentrations in uremics were increased at 0 time (p < 0.02), lower at 20 minutes (p < 0.01) and increased at 120 minutes (p < 0.02). No difference existed between HD and CAPD. The thyroid response to TSH was normal as showed by a normal percent increase over basal values of T3concentrations at 120 minutes. Uremic patients also showed a peak GH response at 20 minutes which was not observed in controls. The data exclude the existence on a primary form of hypothyroidism and point to the existence of hypothalamic-pituitary abnormalities, which should not be taken as indicative of secondary and/or tertiary hypothyroidism since FT4values were normal in HD and increased in patients undergoing CAPD (p < 0.05) who on turn showed lower plasma albumin concentrations (p < 0.05).

Studies in patients with uremia due to diabetes mellitus treated with CAPD show that the kinetics of amino acid equilibration between dialysate and plasma behave differently from those in patients with uremia of different etiology. Diabetics also have larger amino acid losses in dialysate.

Thyroid function was explored in 27 CAPD patients and 25 HD patients. Dialysis was associated with low T3and T4levels, increased rT3concentrations, normal T4: T3and reduced T4: rT3ratios, normal FT3and Thyroglobulin concentrations. TSH levels increased during dialysis but still fell within normal limits. The data rule out a condition of primary hypothyroidism and point out to increased thyroidal dismission associated with the block T4-T3in peripheral cells. Also the increased FT4levels in CAPD patients could be due to de novo dismission of thyroidal T4.

This work was presented in part at the 12th Annual Contractor's Conference of the National Institutes of Arthritis, Metabolism and Digestive Diseases, Bethesda, USA, January 15, 1979 and the Congress of the International Society for Artificial Internal Organs at the symposium on CAPD, New York Hilton, New York, April 19, 1979.