Prospective study of thyroid functions in children with chronic kidney disease

Prospective study of thyroid functions in children with chronic kidney disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prospective study of thyroid functions in children with chronic kidney disease Dr.Qudsiya Ansari, Dr.Alpana Ohri This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1761891/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Nephro-endocrine association has been known for a long time. The kidney contributes to clearance of iodine primarily by glomerular filtration. As iodine excretion is diminished in advanced renal failure, leading to an elevated plasma inorganic iodide concentration and initial increment in throidal iodide uptake. Increased total body iodide can potentially block thyroid hormone production by affecting the pituitary-thyroid axis and peripheral metabolism of thyroid hormone .So, thyroid dysfunction is commonly seen endocrine abnormality among CKD patients. A hospital based prospective observational study was conducted with 66 children to assess the prevalence of abnormal thyroid functions in children with chronic kidney disease and to correlate abnormal thyroid functions with different etiologies of chronic kidney disease and different stages of chronic kidney disease. It has been shown that in CKD, as the GFR falls there is a higher possibility of developing clinical and subclinical hypothyroidism. subclinical hypothyroidism chronic kidney disease Introduction Chronic kidney disease (CKD) is a major health problem worldwide with increasing incidence and prevalence that is threatening to bring on the onset of a real ‘epidemic’. In children, it can be a devastating illness with many long-term consequences. Independent of the initial cause, CKD is a clinical syndrome characterized by a gradual loss of kidney function over time. In particular, the Kidney Disease Improving Global Outcomes (KDIGO) guidelines have defined CKD as abnormalities of kidney structure or function, present for more than 3 months. The interplay between thyroid and the kidney in each other's functions is known for many years. 1 Thyroid dysfunction affects renal physiology and development, whereas kidney disease could result in thyroid dysfunction. Disorders of the thyroid and kidney may co-exist with common etiological factors. The kidney normally contributes to the clearance of iodide, primarily by glomerular filtration. Thus, iodide excretion is diminished in advanced renal failure, leading sequentially to an elevated plasma inorganic iodide concentration and an initial increment in thyroidal iodide uptake. The ensuing marked increase in the intra thyroidal iodide pool results in diminished uptake of radio labeled iodide by the thyroid in uremic patients. 2 Increases in total body inorganic iodide can potentially block thyroid hormone production (the Wolff-Chaikoff effect). Such a change may explain the slightly higher frequency of goiter and hypothyroidism in patients with chronic kidney disease. 3 Thyroid functional disorders are commonly observed in chronic kidney disease (CKD) patients, various thyroid functional test abnormalities are frequently seen in CKD patients, resulting from alterations in thyroid hormone synthesis, metabolism, and regulation. The relation between thyroid dysfunction and severity of CKD is not clear. Several previous studies depict conflicting results both positive and negative. Thus, there are huge numbers of patients remaining to be diagnosed and/or treated.Hence the present study was done at our tertiary care centre to study the prevalence of abnormal thyroid functions in children with chronic kidney disease and correlate abnormal thyroid functions with different etiologies of chronic kidney disease and different stages of chronic kidney disease. Methodology Aims and Objective: 1) To study the prevalence of abnormal thyroid functions in children with chronic kidney disease. 2) To correlate abnormal thyroid functions with different etiologies of chronic kidney disease and different stages of chronic kidney disease Study design : A hospital based prospective observational study Study Duration : 18 months S tudy area : The study was done at our tertiary care centre in the department of Pediatrics, OPD of BJWCH on attending OPD/IPD. Study population : All CKD children attending the OPD of BJWCH and newly diagnosed CKD children admitted in ward or coming in the OPD after metabolic stabilization at our Tertiary care Hospital who fulfilled the inclusion criteria. Sample size: 66 patients Sample size was calculated using the formula: n= [z 2 p(1-p)]/d 2 Where: Z = table value of alpha error from Standard Normal Distribution table (0.95) Power (p) = 80% Precision error of estimation (d) = 4.75% n= [0.95 x 0.95 x 0.8 (0.2)] / 0.0475 x 0.0475 = 64 Hence sample size of 66 children were selected for the study. Inclusion criteria All patients diagnosed as chronic kidney disease in accordance with KDOQI guidelines having less than 18 years of age Exclusion criteria: Patients who have pre-existing hypothyroidism/ hyperthyroidism. CKD patients on drugs which are known to affect thyroid function like interferon etc. CKD child in acute decompensation. The study was done at our tertiary care centre on all CKD children in the department of Pediatrics, OPD of BJWCH on attending OPD/IPD after due permission from the Institutional Ethics Committee and Review Board and after taking Written Informed Consent from the patients. After approval from the Institutional Ethics Committee a valid informed consent was taken. Once the patients were enrolled for the study, a thorough history and physical examination was done as per proforma. An informed consent was taken in written from patients or patient’s attendant. It is a single centre prospective observational study. Study was done at our tertiary care centre on patients coming for the follow up in CKD OPD of BJWCH and newly diagnosed CKD children admitted in ward or coming in the OPD after metabolic stabilization. Patients fulfilling the inclusion criteria were enrolled in the study after taking parental informed consent or assent. A study proforma was made which focused on demographic features, caste, residence location, source of water, kind of salt consumed, family history of hypothyroidism, age at the diagnosis of CKD, clinical features and baseline laboratory tests, different stages of CKD. Additionally history, examination was done to look for clinical features of hypothyroidism-history, thyroid swelling. All recruited patients had undergone examination to look for of serum Free T3, T4, TSH at the time of enrollment. These all investigations are routinely done in chronic kidney disease patient coming to OPD for follow up. BUN Cl Creatinine pH Egfr pCO2 Calcium HCO3 Phosphrus Free T3 Alkaline phosphate Free T4 Na+ TSH K+ Serum Albumin Urine routine microscopy 24hrs urine albumin Results And Discussion A hospital based prospective observational study was conducted with 66 children to assess the prevalence of abnormal thyroid functions in children with chronic kidney disease and to correlate abnormal thyroid functions with different etiologies of chronic kidney disease and different stages of chronic kidney disease. Distribution of children as per Thyroid Function Test Results 28 out of 66 children had thyroid disorders. The prevalence of thyroid disorders in our study was 42.4%. The prevalence of subclinical hypothyroidism and hypothyroidism was 33.3% and 9.1% respectively (Table & graph 1). Distribution of children according to Age The mean age of children with subclinical hypothyroid and hypothyroid was 6.95 ± 2.94 years and 6.83 ± 3.82 years respectively while the mean age of euthyroid children was 6.97 ± 3.21 years. There was no significant difference between the groups as per ANOVA test (p>0.05)(table & graph 2). Distribution of children according to Sex 16 (72.7%) and 6 (27.3%) children with subclinical hypothyroid were male and female respectively while 4 (66.7%) and 2 (33.3%) children with hypothyroid were male and female respectively. 27 (71.1%) and 11 (28.9%) euthyroid children were male and female respectively. There was no significant difference between the groups as per Chi-Square test (p>0.05) (table & graph 3). Anthropometry measurements of children The mean height of children with subclinical hypothyroid and hypothyroid was 105.95 ± 15.19 cms and 102.17 ± 24.01 cms respectively while the mean height of euthyroid children was 105.47 ± 16.28 cms. The mean weight of children with subclinical hypothyroid and hypothyroid was 16.41 ± 6.27 kgs and 15.02 ± 6.29 kgs respectively while the mean weight of euthyroid children was 16.58 ± 6.59 kgs. There was no significant difference between the groups as per ANOVA test (p>0.05) (table & graph 4). Distribution of children according to Age of Onset of Disease The mean age of onset of disease of children with subclinical hypothyroid and hypothyroid was 3.71 ± 2.5 years and 4.38 ± 3.90 years respectively while the mean age of onset of disease of euthyroid children was 3.69 ± 2.55 years. There was no significant difference between the groups as per ANOVA test (p>0.05) (table & graph 5). Distribution of children according to Family History of Thyroid Dysfunction No child with subclinical hypothyroid and hypothyroid had family history of thyroid dysfunction while 2 (5.3%) euthyroid children had family history of thyroid dysfunction. There was no significant difference between the groups as per Chi-Square test (p>0.05) (table & graph 6). Distribution of children according to Clinical Presentation 1 (4.5%) and 2 (9.1%) children with subclinical hypothyroid had constipation and sensitivity to cold / dry skin respectively while 1 (16.7%) child with hypothyroid had sensitivity to cold / dry skin. 2 (5.3%) and 3 (7.9%) euthyroid children had constipation and sensitivity to cold / dry skin respectively. There was no significant difference between the groups as per Chi-Square test (p>0.05) (table & graph 7). Distribution of children according to Treatment History 17 (77.3%) and 18 (81.8%) children with subclinical hypothyroid were prescribed anti HTN and EPO injection respectively while 21 (95.4%) and 22 (100%) children were on iron and calcium supplementation respectively. 5 (83.3%) and 6 (100%) children with hypothyroid were prescribed anti HTN and EPO injection respectively while 5 (83.3%) and 6 (100%) children were on iron and calcium supplementation respectively. 30 (78.9%) and 31 (81.6%) euthyroid children were prescribed anti HTN and EPO injection respectively while 36 (94.7%) and 38 (100%) children were on iron and calcium supplementation respectively. There was no significant difference between the groups as per Chi-Square test (p>0.05) (table & graph 8). Distribution of children according to Proteinuric CKD 4 (18.2%) and 1 (16.7%) child with subclinical hypothyroid and hypothyroid respectively had proteinuric CKD while 10 (26.3%) euthyroid children had proteinuric CKD. There was no significant difference between the groups as per Chi-Square test (p>0.05) (table & graph 9). Distribution of children according to Biochemical parameters The mean BUN, creatinine and eGFR values of children with subclinical hypothyroid were 46.14±18.53mg/dL, 3.27±2.27mg/dL and 21.14±12.19 ml/min/1.73m 2 respectively. The mean BUN, creatinine and eGFR values of children with hypothyroid were 38.67±15.54mg/dL, 4.88±1.92mg/dL and 22.08±21.05 ml/min/1.73m 2 respectively. The mean BUN, creatinine and eGFR values of euthyroid children were 48.45±19.81mg/dL, 3.43±2.46mg/dL and 21.74±12.46 ml/min/1.73m 2 respectively. There was no significant difference between the groups as per Chi-Square test (p>0.05) (table & graph 10). Correlation of CKD Stage with Thyroid function of children 3 (13.6%) and 10 (45.5%) children with subclinical hypothyroid had Stage 3 and Stage 4 CKD respectively while 9 (40.9%) children had Stage 5 CKD. 2 (33.3%) and 4 (66.7%) children with hypothyroid had Stage 3 and Stage 5 CKD respectively. 4 (10.5%) and 19 (50%) euthyroid children had Stage 3 and Stage 4 CKD respectively while 15 (39.5%) children had Stage 5 CKD. It was observed that with increasing severity of CKD, hypothyroidism also increase from 33.3% in stage 3 to 66.7% in stage 5 CKD. There was correlation of CKD Stage with thyroid function of children as per Chi-Square test ( p<0.05 ) (table & graph 11). Correlation of eGFR with thyroid function parameters It was observed that with decrease in eGFR values there was significant increase in TSH values and significant decrease in FT3 values while the difference in FT4 value was comparable. There was significant correlation of eGFR with TSH and FT3 values as per ANOVA test ( p<0.05 ) (table & graph 12). The interplay between thyroid and the kidney in each other's functions is known for many years. Thyroid dysfunction affects renal physiology and development, whereas kidney disease could result in thyroid dysfunction. Disorders of the thyroid and kidney may co-exist with common etiological factors. In addition, treatment strategies of one disease may affect those of the other organ. There are several interactions between thyroid and kidney functions in each other organ's disease states. Thyroid hormones affect renal development and physiology. Thyroid hormones have pre-renal and intrinsic renal effects by which they increase the renal blood flow and the glomerular filtration rate (GFR). Hypothyroidism is associated with reduced GFR and hyperthyroidism results in increased GFR as well as increased renin – angiotensin – aldosterone activation. CKD patients also have increased incidence of primary hypothyroidism and subclinical hypothyroidism. In the present study, 28 out of 66 children had thyroid disorders. The prevalence of thyroid disorders in our study was 42.4%. The prevalence of subclinical hypothyroidism and hypothyroidism was 33.3% and 9.1% respectively. This is similar to the studies of El-Hana NA et al 19 and Bajaj S et al 20 . Conclusion There are various mechanisms of interaction between kidney and thyroid functions in the disease states of each other organ. Thyroid dysfunction is very common in CKD patients and reveals the significant association between CKD progression and thyroid dysfunction and mean of T3, T4 decreases and TSH increases significantly in CKD. A decrease in eGFR values was significant increase in TSH values and significant decrease in FT3 values while the difference in FT4 value was comparable. There was significant correlation of eGFR with TSH and FT3 values.Health professionals caring for patients with CKD should be cognizant that CKD and hypothyroidism may exhibit overlapping symptom complexes. Hyperthyroidism which was found in some previous studies was not found in this study. Declarations Funding: Patients have paid for the tests. Authors' contributions: Dr.Qudsiya Ansari has done this study under Dr.Alpana Ohri’s guidance. Ethics approval: Ethics approval has be taken from Institutional Ethics committee of KEM hospital before starting the study. Consent to participate: informed consent has been taken from patients for the study and publication. Conflicts of interest/Competing interests: not applicable Availability of data and material: all data reports collected during study is available with author. References Kaptein EM. Thyroid function in renal failure. Contrib Nephrol. 1986;50:64–72. Ramírez G, Jubiz W, Gutch CF et al. Thyroid abnormalities in renal failure. A study of 53 patients on chronic hemodialysis. Ann Intern Med. 1973;79:500. Kaptein EM. Thyroid hormone metabolism and thyroid diseases in chronic renal failure. Endocr Rev. 1996;17:454-63. Dallas JS and Foley TP Jr, Hypothyroidism In: Paed Endocrinology by Fima Lifshitz, 2006:469-481. Lo JC, Chertow GM, Go AS ET AL. Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease. Kidney international. 2005;67:10474–1052. Chonchol M, Lippi G, Salvagno G et al. Prevalence of subclinical hypothyroidism in patients with chronic kidney disease. Clinical journal of the American Society of Nephrology: CJASN. 2008;3:12964–1300. Wijkhuisen A, Djouadi F, Vilar J et al. Thyroid hormones regulate development of energy metabolism enzymes in rat proximal convoluted tubule. Am J Physiol. 1995;268:F634–42 Den Hollander JG, Wulkan RW, Mantel MJ et al. Correlation between severity of thyroid dysfunction and renal function. Clin Endocrinol (Oxf). 2005; 62:423–7. Kobori H, Ichihara A, Miyashita Y et al. Mechanism of hyperthyroidism-induced renal hypertrophy in rats. J Endocrinol. 1998;159:9–14. Kimmel M, Braun N, Alscher M. Influence of thyroid function on different kidney function tests. Kidney Blood Press Res. 2012;35:9–17. Suher M, Koc E, Ata N et al. Relation of thyroid disfunction, thyroid autoantibodies, and renal function. Ren Fail. 2005;27:739–42. Van Welsem ME, Lobatto S. Treatment of severe hypothyroidism in a patient with progressive renal failure leads to significant improvement of renal function. Clin Nephrol. 2007;67:391–3. Mariani LH, Berns JS. The renal manifestations of thyroid disease. Journal of the American Society of Nephrology: JASN. 2012; 23:224–26. Kreisman SH, Hennessey JV. Consistent reversible elevations of serum creatinine levels in severe hypothyroidism. Archives of internal medicine. 1999;159:794–82. Villabona C, Sahun M, Roca M et al. Blood volumes and renal function in overt and subclinical primary hypothyroidism. The American journal of the medical sciences. 1999;318:2774–280. Rhee CM, Bhan I, Alexander EK et al. Association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism. Archives of internal medicine. 2012;172:1534–159. Silverberg DS, Ulan RA, Fawcett DM et al. Effects of chronic hemodialysis on thyroid function in chronic renal failure. Can Med Assoc J. 1973; 109:282–6. Kaptein EM, Levenson H, Siegel ME et al. Radioiodine dosimetry in patients with end-stage renal disease receiving continuous ambulatory peritoneal dialysis therapy. J Clin Endocrinol Metab. 2000;85:3058–64. El-Hana NA, El Shaikh S, Shaheen FA. Thyroid Function in Children with Chronic Renal Failure. Saudi J Kidney Dis Transpl. 1996; 7:297-300. Bajaj S, Purwar N, Gupta A et al. Prevalence of hypothyroidism in nondiabetic chronic kidney disease and effect of thyroxine replacement on estimated glomerular filtration rate. Indian J Nephrol. 2017;27:104-7. Punekar J, Singh AA, Malav MK. Study of thyroid function in patients with chronic kidney disease. Int J Health Sci Res. 2017;7(2):68-72. Gupta UN, Jain A, Prakash P etal. To study the prevalence of thyroid disorders in chronic renal disease patients. J Integr Nephrol Androl. 2018;5:126-9. Tables Table 1: Distribution of children as per Thyroid Function Test Results Thyroid Status N % Subclinical Hypothyroidism 22 33.3% Hypothyroidism 6 9.1% Euthyroid 38 57.6% Total 66 100% Table 2: Distribution of children according to Age Age (years) Subclinical Hypothyroid Hypothyroid Euthyroid p Value N % N % N % 1-4 years 5 22.7% 2 33.3% 10 26.3% >0.05 5- 8 years 13 59.1% 2 33.3% 20 52.7% 9-12 years 2 9.1% 1 16.7% 4 10.5% >12 years 2 9.1% 1 16.7% 4 10.5% Total 22 100% 6 100% 38 100% Mean ± SD 6.95 ± 2.94 6.83 ± 3.82 6.97 ± 3.21 Table 3: Distribution of children according to Sex Sex Subclinical Hypothyroid Hypothyroid Euthyroid p Value N % N % N % Male 16 72.7% 4 66.7% 27 71.1% >0.05 Female 6 27.3% 2 33.3% 11 28.9% Total 22 100% 6 100% 38 100% Table 4: Anthropometry measurements of children Anthropometry measurements Subclinical Hypothyroid Hypothyroid Euthyroid p Value Mean SD Mean SD Mean SD Height (cms) 105.95 15.19 102.17 24.01 105.47 16.28 >0.05 Weight (kgs) 16.41 6.27 15.02 6.29 16.58 6.59 Table 5: Distribution of children according to Age of Onset of Disease Age of Onset of Disease (years) Subclinical Hypothyroid Hypothyroid Euthyroid p Value N % N % N % 0.05 1-3 years 8 36.4% 2 33.3% 16 42.2% >3 years 4 18.2% 2 33.3% 8 21.1% Total 22 100% 6 100% 38 100% Mean ± SD 3.71 ± 2.58 4.38 ± 3.90 3.69 ± 2.55 Table 6: Distribution of children according to Family History of Thyroid Dysfunction Family History of Thyroid Dysfunction Subclinical Hypothyroid Hypothyroid Euthyroid p Value N % N % N % Yes 0 - 0 - 2 5.3% >0.05 No 22 100% 6 100% 36 94.7% Total 22 100% 6 100% 38 100% Table 7: Distribution of children according to Clinical Presentation Clinical Presentation Subclinical Hypothyroid Hypothyroid Euthyroid p Value N % N % N % Constipation 1 4.5% 0 - 2 5.3% >0.05 Sensitivity to Cold / Dry Skin 2 9.1% 1 16.7% 3 7.9% Table 8: Distribution of children according to Treatment History Treatment History Subclinical Hypothyroid Hypothyroid Euthyroid p Value N % N % N % Anti HTN 17 77.3% 5 83.3% 30 78.9% >0.05 EPO Injection 18 81.8% 6 100% 31 81.6% Iron Supplementation 21 95.4% 5 83.3% 36 94.7% Calcium Supplementation 22 100% 6 100% 38 100% Table 9: Distribution of children according to Proteinuric CKD Subclinical Hypothyroid Hypothyroid Euthyroid p Value N % N % N % Proteinuric CKD 4 18.2% 1 16.7% 10 26.3% >0.05 Non-Proteinuric CKD 18 81.8% 5 83.3% 28 73.7% Total 22 100% 6 100% 38 100% Table 10: Distribution of children according to Biochemical parameters Biochemical parameters Subclinical Hypothyroid Hypothyroid Euthyroid p Value Mean SD Mean SD Mean SD BUN 46.14 18.53 38.67 15.54 48.45 19.81 >0.05 Creatinine 3.27 2.27 4.88 1.92 3.43 2.46 eGFR 21.14 12.19 22.08 21.05 21.74 12.46 Table 11: Correlation of CKD Stage with Thyroid function of children CKD Stage Subclinical Hypothyroid Hypothyroid Euthyroid p Value N % N % N % Stage 3 3 13.6% 2 33.3% 4 10.5% <0.05 Stage 4 10 45.5% 0 - 19 50% Stage 5 9 40.9% 4 66.7% 15 39.5% Total 22 100% 6 100% 38 100% Table 12: Correlation of eGFR with thyroid function parameters eGFR (ml/min/1.73m 2 ) TSH FT3 FT4 Mean SD Mean SD Mean SD <15 7.03 4.64 2.16 0.75 0.93 0.22 15-30 4.61 2.07 2.95 0.42 1.06 0.25 ≥30 2.62 1.78 3.72 0.97 1.53 0.39 p Value <0.05 0.05 Graphs Graph 1 to 12 is available in Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Graph.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1761891","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":115544854,"identity":"31cd7fbb-5c4f-4545-be48-1bc5e35cf7c8","order_by":0,"name":"Dr.Qudsiya Ansari","email":"data:image/png;base64,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","orcid":"","institution":"Bai Jerbai Wadia Hospital for Children","correspondingAuthor":true,"submittingAuthor":false,"prefix":"Dr.","firstName":"Qudsiya","middleName":"","lastName":"Ansari","suffix":""},{"id":115544855,"identity":"1e1b8217-0fbf-4cae-aa38-3a7026a6eb71","order_by":1,"name":"Dr.Alpana Ohri","email":"","orcid":"","institution":"Bai Jerbai Wadia Hospital for Children","correspondingAuthor":false,"submittingAuthor":false,"prefix":"Dr.","firstName":"Alpana","middleName":"","lastName":"Ohri","suffix":""}],"badges":[],"createdAt":"2022-06-15 15:29:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1761891/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1761891/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":23326789,"identity":"f37ffdeb-3ae4-4b4d-b06e-62687b54cb0c","added_by":"auto","created_at":"2022-07-01 14:34:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":754664,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1761891/v1/4fe1bb8d-e380-4f2a-8ed0-03d3537d1b18.pdf"},{"id":23326783,"identity":"8b410791-e0fa-486d-ae74-44ee20f917eb","added_by":"auto","created_at":"2022-07-01 14:34:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":754664,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1761891/v1/d01f5895-ad1d-4447-a69f-0432af76a560.pdf"},{"id":23326744,"identity":"462ffeba-5507-45d3-81f3-5011dec018ab","added_by":"auto","created_at":"2022-07-01 14:34:51","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":41981,"visible":true,"origin":"","legend":"","description":"","filename":"Graph.docx","url":"https://assets-eu.researchsquare.com/files/rs-1761891/v1/8df187e409f4e3bc6ce4ca8e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prospective study of thyroid functions in children with chronic kidney disease","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChronic kidney disease (CKD) is a major health problem worldwide with increasing incidence and prevalence that is threatening to bring on the onset of a real \u0026lsquo;epidemic\u0026rsquo;. In children, it can be a devastating illness with many long-term consequences. Independent of the initial cause, CKD is a clinical syndrome characterized by a gradual loss of kidney function over time. In particular, the Kidney Disease Improving Global Outcomes (KDIGO) guidelines have defined CKD as abnormalities of kidney structure or function, present for more than 3 months. The interplay between thyroid and the kidney in each other\u0026apos;s functions is known for many years.\u003csup\u003e1\u003c/sup\u003e Thyroid dysfunction affects renal physiology and development, whereas kidney disease could result in thyroid dysfunction. Disorders of the thyroid and kidney may co-exist with common etiological factors. The kidney normally contributes to the clearance of iodide, primarily by glomerular filtration. Thus, iodide excretion is diminished in advanced renal failure, leading sequentially to an elevated plasma inorganic iodide concentration and an initial increment in thyroidal iodide uptake. The ensuing marked increase in the intra thyroidal iodide pool results in diminished uptake of radio labeled iodide by the thyroid in uremic patients.\u003csup\u003e2\u003c/sup\u003e Increases in total body inorganic iodide can potentially block thyroid hormone production (the Wolff-Chaikoff effect). Such a change may explain the slightly higher frequency of goiter and hypothyroidism in patients with chronic kidney disease.\u003csup\u003e3\u003c/sup\u003eThyroid functional disorders are commonly observed in chronic kidney disease (CKD) patients, various thyroid functional test abnormalities are frequently seen in CKD patients, resulting from alterations in thyroid hormone synthesis, metabolism, and regulation.\u003c/p\u003e\n\u003cp\u003eThe relation between thyroid dysfunction and severity of CKD is not clear. Several previous studies depict conflicting results both positive and negative. Thus, there are huge numbers of patients remaining to be diagnosed and/or treated.Hence the present study was done at our tertiary care centre to study the prevalence of abnormal thyroid functions in children with chronic kidney disease and correlate abnormal thyroid functions with different etiologies of chronic kidney disease and different stages of chronic kidney disease.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eAims and Objective:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1)\u0026nbsp;To study the prevalence of abnormal thyroid functions in children with chronic kidney disease.\u003c/p\u003e\n\u003cp\u003e2) To correlate abnormal thyroid functions with different etiologies of chronic kidney disease and different stages of chronic kidney disease\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudy design\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eA hospital based prospective observational study\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudy Duration\u003cstrong\u003e:\u003c/strong\u003e 18 months\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eS\u003c/strong\u003etudy area\u003cstrong\u003e:\u003c/strong\u003e The study\u0026nbsp;was done at our tertiary care centre\u0026nbsp;in the department of Pediatrics, OPD of BJWCH\u0026nbsp;on\u0026nbsp;attending OPD/IPD.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudy population\u003cstrong\u003e:\u003c/strong\u003e All CKD children attending the OPD of BJWCH and newly diagnosed CKD children admitted in ward or coming in the OPD after metabolic stabilization at our Tertiary care Hospital who fulfilled the inclusion criteria.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSample size:\u0026nbsp;66 patients\u003c/p\u003e\n\u003cp\u003eSample size was calculated\u0026nbsp;using the formula:\u003c/p\u003e\n\u003cp\u003en= [z\u003csup\u003e2\u003c/sup\u003ep(1-p)]/d\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eWhere: Z = table value of alpha error from Standard Normal Distribution table (0.95)\u003c/p\u003e\n\u003cp\u003ePower (p) = 80%\u003c/p\u003e\n\u003cp\u003ePrecision error of estimation (d) = 4.75%\u003c/p\u003e\n\u003cp\u003en= [0.95 x 0.95 x 0.8 (0.2)] / 0.0475 x 0.0475 = 64\u003c/p\u003e\n\u003cp\u003eHence sample size of 66 children were selected for the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eAll patients diagnosed as chronic kidney disease in accordance with KDOQI guidelines having less than 18 years of age\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePatients who have pre-existing hypothyroidism/ hyperthyroidism.\u003c/li\u003e\n \u003cli\u003eCKD patients on drugs which are known to affect thyroid function like interferon etc.\u003c/li\u003e\n \u003cli\u003eCKD child in acute decompensation.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe study was done at our tertiary care centre on all CKD children in the department of Pediatrics, OPD of BJWCH on attending OPD/IPD after due permission from the Institutional Ethics Committee and Review Board and after taking Written Informed Consent from the patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAfter approval from the Institutional Ethics Committee a valid informed consent was taken. Once the patients were enrolled for the study, a thorough history and physical examination was done as per proforma. An informed consent was taken in written from patients or patient\u0026rsquo;s attendant.\u003c/p\u003e\n\u003cp\u003eIt is a single centre prospective observational study. Study was done at our tertiary care centre on patients coming for the follow up in CKD OPD of BJWCH and newly diagnosed CKD children admitted in ward or coming in the OPD after metabolic stabilization. Patients fulfilling the inclusion criteria were enrolled in the study after taking parental informed consent or assent. \u0026nbsp;A study proforma was made which focused on demographic features, caste, residence location, source of water, kind of salt consumed, family history of hypothyroidism, age at the diagnosis of CKD, clinical features and baseline laboratory tests, different stages of CKD.\u003c/p\u003e\n\u003cp\u003eAdditionally history, examination was done to look for clinical features of hypothyroidism-history, thyroid swelling. All recruited patients had undergone examination to look for of serum Free T3, T4, TSH at the time of enrollment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese all investigations are routinely done in chronic kidney disease patient coming to OPD for follow up.\u003c/p\u003e\n\u003cp\u003eBUN \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Cl\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCreatinine \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;pH\u003c/p\u003e\n\u003cp\u003eEgfr \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;pCO2\u003c/p\u003e\n\u003cp\u003eCalcium \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;HCO3\u003c/p\u003e\n\u003cp\u003ePhosphrus \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Free T3\u003c/p\u003e\n\u003cp\u003eAlkaline phosphate \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Free T4\u003c/p\u003e\n\u003cp\u003eNa+ \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;TSH\u003c/p\u003e\n\u003cp\u003eK+ \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Serum Albumin\u003c/p\u003e\n\u003cp\u003eUrine routine microscopy \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 24hrs urine albumin\u003c/p\u003e"},{"header":"Results And Discussion","content":"\u003cp\u003eA hospital based prospective observational study was conducted with 66 children to assess the prevalence of abnormal thyroid functions in children with chronic kidney disease and to correlate abnormal thyroid functions with different etiologies of chronic kidney disease and different stages of chronic kidney disease.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of children as per Thyroid Function Test Results\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e28 out of 66 children had thyroid disorders. The prevalence of thyroid disorders in our study was 42.4%. The prevalence of subclinical hypothyroidism and hypothyroidism was 33.3% and 9.1% respectively (Table \u0026amp; graph 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of children according to Age\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean age of children with subclinical hypothyroid and hypothyroid was 6.95 \u0026plusmn; 2.94 years and 6.83 \u0026plusmn; 3.82 years respectively while the mean age of euthyroid children was 6.97 \u0026plusmn; 3.21 years. There was no significant difference between the groups as per ANOVA test (p\u0026gt;0.05)(table \u0026amp; graph 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of children according to Sex\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e16 (72.7%) and 6 (27.3%) children with subclinical hypothyroid were male and female respectively while 4 (66.7%) and 2 (33.3%) children with hypothyroid were male and female respectively. 27 (71.1%) and 11 (28.9%) euthyroid children were male and female respectively. There was no significant difference between the groups as per Chi-Square test (p\u0026gt;0.05) (table \u0026amp; graph 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnthropometry measurements of children\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean height of children with subclinical hypothyroid and hypothyroid was 105.95 \u0026plusmn; 15.19 cms and 102.17 \u0026plusmn; 24.01 cms respectively while the mean height of euthyroid children was 105.47 \u0026plusmn; 16.28 cms. The mean weight of children with subclinical hypothyroid and hypothyroid was 16.41 \u0026plusmn; 6.27 kgs and 15.02 \u0026plusmn; 6.29 kgs respectively while the mean weight of euthyroid children was 16.58 \u0026plusmn; 6.59 kgs. There was no significant difference between the groups as per ANOVA test (p\u0026gt;0.05) (table \u0026amp; graph 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of children according to Age of Onset of Disease\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean age of onset of disease of children with subclinical hypothyroid and hypothyroid was 3.71 \u0026plusmn; 2.5 years and 4.38 \u0026plusmn; 3.90 years respectively while the mean age of onset of disease of euthyroid children was 3.69 \u0026plusmn; 2.55 years. There was no significant difference between the groups as per ANOVA test (p\u0026gt;0.05) (table \u0026amp; graph 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of children according to Family History of Thyroid Dysfunction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo child with subclinical hypothyroid and hypothyroid had family history of thyroid dysfunction while 2 (5.3%) euthyroid children had family history of thyroid dysfunction. There was no significant difference between the groups as per Chi-Square test (p\u0026gt;0.05) (table \u0026amp; graph 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of children according to Clinical Presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 (4.5%) and 2 (9.1%) children with subclinical hypothyroid had constipation and sensitivity to cold / dry skin respectively while 1 (16.7%) child with hypothyroid had sensitivity to cold / dry skin. \u0026nbsp;2 (5.3%) and 3 (7.9%) euthyroid children had constipation and sensitivity to cold / dry skin respectively. There was no significant difference between the groups as per Chi-Square test (p\u0026gt;0.05) (table \u0026amp; graph 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of children according to Treatment History\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e17 (77.3%) and 18 (81.8%) children with subclinical hypothyroid were prescribed anti HTN and EPO injection respectively while 21 (95.4%) and 22 (100%) children were on iron and calcium supplementation respectively. 5 (83.3%) and 6 (100%) children with hypothyroid were prescribed anti HTN and EPO injection respectively while 5 (83.3%) and 6 (100%) children were on iron and calcium supplementation respectively.\u003c/p\u003e\n\u003cp\u003e30 (78.9%) and 31 (81.6%) euthyroid children were prescribed anti HTN and EPO injection respectively while 36 (94.7%) and 38 (100%) children were on iron and calcium supplementation respectively. There was no significant difference between the groups as per Chi-Square test (p\u0026gt;0.05) (table \u0026amp; graph 8).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of children according to Proteinuric CKD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e4 (18.2%) and 1 (16.7%) child with subclinical hypothyroid and hypothyroid respectively had proteinuric CKD while 10 (26.3%) euthyroid children had proteinuric CKD. There was no significant difference between the groups as per Chi-Square test (p\u0026gt;0.05) (table \u0026amp; graph 9).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of children according to Biochemical parameters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean BUN, creatinine and eGFR values of children with subclinical hypothyroid were 46.14\u0026plusmn;18.53mg/dL, 3.27\u0026plusmn;2.27mg/dL and 21.14\u0026plusmn;12.19 ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e respectively. The mean BUN, creatinine and eGFR values of children with hypothyroid were 38.67\u0026plusmn;15.54mg/dL, 4.88\u0026plusmn;1.92mg/dL and 22.08\u0026plusmn;21.05 ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e respectively.\u003c/p\u003e\n\u003cp\u003eThe mean BUN, creatinine and eGFR values of euthyroid children were 48.45\u0026plusmn;19.81mg/dL, 3.43\u0026plusmn;2.46mg/dL and 21.74\u0026plusmn;12.46 ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e respectively. There was no significant difference between the groups as per Chi-Square test (p\u0026gt;0.05) (table \u0026amp; graph 10).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation of CKD Stage with Thyroid function of children\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e3 (13.6%) and 10 (45.5%) children with subclinical hypothyroid had Stage 3 and Stage 4 CKD respectively while 9 (40.9%) children had Stage 5 CKD. 2 (33.3%) and 4 (66.7%) children with hypothyroid had Stage 3 and Stage 5 CKD respectively.\u003c/p\u003e\n\u003cp\u003e4 (10.5%) and 19 (50%) euthyroid children had Stage 3 and Stage 4 CKD respectively while 15 (39.5%) children had Stage 5 CKD. It was observed that with increasing severity of CKD, hypothyroidism also increase from 33.3% in stage 3 to 66.7% in stage 5 CKD. There was correlation of CKD Stage with thyroid function of children as per Chi-Square test (\u003cstrong\u003ep\u0026lt;0.05\u003c/strong\u003e) (table \u0026amp; graph 11).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation of eGFR with thyroid function parameters\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt was observed that with decrease in eGFR values there was significant increase in TSH values and significant decrease in FT3 values while the difference in FT4 value was comparable. There was significant correlation of eGFR with TSH and FT3 values as per ANOVA test (\u003cstrong\u003ep\u0026lt;0.05\u003c/strong\u003e) (table \u0026amp; graph 12).\u003c/p\u003e\n\u003cp\u003eThe interplay between thyroid and the kidney in each other\u0026apos;s functions is known for many years. Thyroid dysfunction affects renal physiology and development, whereas kidney disease could result in thyroid dysfunction. Disorders of the thyroid and kidney may co-exist with common etiological factors. In addition, treatment strategies of one disease may affect those of the other organ.\u003c/p\u003e\n\u003cp\u003eThere are several interactions between thyroid and kidney functions in each other organ\u0026apos;s disease states. Thyroid hormones affect renal development and physiology. Thyroid hormones have pre-renal and intrinsic renal effects by which they increase the renal blood flow and the glomerular filtration rate (GFR). Hypothyroidism is associated with reduced GFR and hyperthyroidism results in increased GFR as well as increased renin \u0026ndash; angiotensin \u0026ndash; aldosterone activation. CKD patients also have increased incidence of primary hypothyroidism and subclinical hypothyroidism.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the present study, 28 out of 66 children had thyroid disorders. The prevalence of thyroid disorders in our study was 42.4%. The prevalence of subclinical hypothyroidism and hypothyroidism was 33.3% and 9.1% respectively. This is similar to the studies of El-Hana NA et al\u003csup\u003e19\u003c/sup\u003e and Bajaj S et al\u003csup\u003e20\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere are various mechanisms of interaction between kidney and thyroid functions in the disease states of each other organ. Thyroid dysfunction is very common in CKD patients and reveals the significant association between CKD progression and thyroid dysfunction and mean of T3, T4 decreases and TSH increases significantly in CKD. A decrease in eGFR values was significant increase in TSH values and significant decrease in FT3 values while the difference in FT4 value was comparable. There was significant correlation of eGFR with TSH and FT3 values.Health professionals caring for patients with CKD should be cognizant that CKD and hypothyroidism may exhibit overlapping symptom complexes. Hyperthyroidism which was found in some previous studies was not found in this study.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding: \u0026nbsp;Patients have paid for the tests.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: Dr.Qudsiya Ansari has done this study under Dr.Alpana Ohri\u0026rsquo;s guidance.\u003c/p\u003e\n\u003cp\u003eEthics approval: Ethics approval has be taken from Institutional Ethics committee of KEM hospital before starting the study.\u003c/p\u003e\n\u003cp\u003eConsent to participate: informed consent has been taken from patients for the study and publication.\u003c/p\u003e\n\u003cp\u003eConflicts of interest/Competing interests: not applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and material: all data reports collected during study is available with author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eKaptein EM. Thyroid function in renal failure. Contrib Nephrol. 1986;50:64\u0026ndash;72.\u003c/li\u003e\n \u003cli\u003eRam\u0026iacute;rez G, Jubiz W, Gutch CF et al. Thyroid abnormalities in renal failure. A study of 53 patients on chronic hemodialysis. Ann Intern Med. 1973;79:500.\u003c/li\u003e\n \u003cli\u003eKaptein EM. Thyroid hormone metabolism and thyroid diseases in chronic renal failure. Endocr Rev. \u0026nbsp;1996;17:454-63.\u003c/li\u003e\n \u003cli\u003eDallas JS and Foley TP Jr, Hypothyroidism In: Paed Endocrinology by Fima Lifshitz, 2006:469-481.\u003c/li\u003e\n \u003cli\u003eLo JC, Chertow GM, Go AS ET AL. Increased prevalence of subclinical and clinical hypothyroidism in persons with chronic kidney disease. Kidney international. 2005;67:10474\u0026ndash;1052.\u003c/li\u003e\n \u003cli\u003eChonchol M, Lippi G, Salvagno G et al. Prevalence of subclinical hypothyroidism in patients with chronic kidney disease. Clinical journal of the American Society of Nephrology: CJASN. 2008;3:12964\u0026ndash;1300.\u003c/li\u003e\n \u003cli\u003eWijkhuisen A, Djouadi F, Vilar J et al. Thyroid hormones regulate development of energy metabolism enzymes in rat proximal convoluted tubule. Am J Physiol. 1995;268:F634\u0026ndash;42\u003c/li\u003e\n \u003cli\u003eDen Hollander JG, Wulkan RW, Mantel MJ et al. Correlation between severity of thyroid dysfunction and renal function. Clin Endocrinol (Oxf). 2005; 62:423\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eKobori H, Ichihara A, Miyashita Y et al. Mechanism of hyperthyroidism-induced renal hypertrophy in rats. J Endocrinol. 1998;159:9\u0026ndash;14.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKimmel M, Braun N, Alscher M. Influence of thyroid function on different kidney function tests. Kidney Blood Press Res. 2012;35:9\u0026ndash;17.\u003c/li\u003e\n \u003cli\u003eSuher M, Koc E, Ata N et al. Relation of thyroid disfunction, thyroid autoantibodies, and renal function. Ren Fail. 2005;27:739\u0026ndash;42.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eVan Welsem ME, Lobatto S. Treatment of severe hypothyroidism in a patient with progressive renal failure leads to significant improvement of renal function. Clin Nephrol. 2007;67:391\u0026ndash;3.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMariani LH, Berns JS. The renal manifestations of thyroid disease. Journal of the American Society of Nephrology: JASN. 2012; 23:224\u0026ndash;26.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKreisman SH, Hennessey JV. Consistent reversible elevations of serum creatinine levels in severe hypothyroidism. Archives of internal medicine. 1999;159:794\u0026ndash;82.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eVillabona C, Sahun M, Roca M et al. Blood volumes and renal function in overt and subclinical primary hypothyroidism. The American journal of the medical sciences. 1999;318:2774\u0026ndash;280.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eRhee CM, Bhan I, Alexander EK et al. Association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism. Archives of internal medicine. 2012;172:1534\u0026ndash;159.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSilverberg DS, Ulan RA, Fawcett DM et al. Effects of chronic hemodialysis on thyroid function in chronic renal failure. Can Med Assoc J. 1973; 109:282\u0026ndash;6.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKaptein EM, Levenson H, Siegel ME et al. Radioiodine dosimetry in patients with end-stage renal disease receiving continuous ambulatory peritoneal dialysis therapy. J Clin Endocrinol Metab. 2000;85:3058\u0026ndash;64.\u003c/li\u003e\n \u003cli\u003eEl-Hana NA, El Shaikh S, Shaheen FA. Thyroid Function in Children with Chronic Renal Failure. Saudi J Kidney Dis Transpl. 1996; 7:297-300.\u003c/li\u003e\n \u003cli\u003eBajaj S, Purwar N, Gupta A et al. Prevalence of hypothyroidism in nondiabetic chronic kidney disease and effect of thyroxine replacement on estimated glomerular filtration rate. Indian J Nephrol. 2017;27:104-7.\u003c/li\u003e\n \u003cli\u003ePunekar J, Singh AA, Malav MK. Study of thyroid function in patients with chronic kidney disease. Int J Health Sci Res. 2017;7(2):68-72.\u003c/li\u003e\n \u003cli\u003eGupta UN, Jain A, Prakash P etal. To study the prevalence of thyroid disorders in chronic renal disease patients. J Integr Nephrol Androl. 2018;5:126-9.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Distribution of children as per Thyroid Function Test Results\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.12261580381471%\"\u003e\n \u003cp\u003e\u003cstrong\u003eThyroid Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.348773841961854%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52861035422343%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.12261580381471%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclinical Hypothyroidism\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.348773841961854%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52861035422343%\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.12261580381471%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypothyroidism\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.348773841961854%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52861035422343%\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.12261580381471%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEuthyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.348773841961854%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52861035422343%\"\u003e\n \u003cp\u003e57.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.12261580381471%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.348773841961854%\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.52861035422343%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Distribution of children according to Age\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"18.24561403508772%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"22.45614035087719%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclinical Hypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 30.75%;\" width=\"24.56140350877193%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"24.210526315789473%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEuthyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5%;\" width=\"10.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.24137931034483%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.625%;\" width=\"16.748768472906406%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.733990147783253%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25615763546798%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.733990147783253%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.24561403508772%\"\u003e\n \u003cp\u003e\u003cstrong\u003e1-4 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.175438596491228%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.280701754385966%\"\u003e\n \u003cp\u003e22.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.625%;\" width=\"11.929824561403509%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e26.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" style=\"width: 5%;\" width=\"10.526315789473685%\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.392156862745097%\"\u003e\n \u003cp\u003e\u003cstrong\u003e5- 8 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.372549019607844%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.72549019607843%\"\u003e\n \u003cp\u003e59.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.625%;\" width=\"13.333333333333334%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.117647058823529%\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.941176470588236%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.117647058823529%\"\u003e\n \u003cp\u003e52.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.392156862745097%\"\u003e\n \u003cp\u003e\u003cstrong\u003e9-12 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.372549019607844%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.72549019607843%\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.625%;\" width=\"13.333333333333334%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.117647058823529%\"\u003e\n \u003cp\u003e16.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.941176470588236%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.117647058823529%\"\u003e\n \u003cp\u003e10.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.392156862745097%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;12 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.372549019607844%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.72549019607843%\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.625%;\" width=\"13.333333333333334%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.117647058823529%\"\u003e\n \u003cp\u003e16.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.941176470588236%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.117647058823529%\"\u003e\n \u003cp\u003e10.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.392156862745097%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.372549019607844%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.72549019607843%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.625%;\" width=\"13.333333333333334%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.117647058823529%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.941176470588236%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.117647058823529%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.392156862745097%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"25.098039215686274%\"\u003e\n \u003cp\u003e6.95 \u0026plusmn; 2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 30.75%;\" width=\"27.45098039215686%\"\u003e\n \u003cp\u003e6.83 \u0026plusmn; 3.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"27.058823529411764%\"\u003e\n \u003cp\u003e6.97 \u0026plusmn; 3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Distribution of children according to Sex\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"15.412186379928315%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"22.939068100358423%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclinical Hypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"25.089605734767026%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"24.731182795698924%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEuthyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"11.827956989247312%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.24137931034483%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.748768472906406%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.733990147783253%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25615763546798%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.733990147783253%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.412186379928315%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.394265232974911%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.544802867383513%\"\u003e\n \u003cp\u003e72.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.186379928315413%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.903225806451612%\"\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.827956989247312%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.903225806451612%\"\u003e\n \u003cp\u003e71.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"11.827956989247312%\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.479674796747968%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.788617886178862%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.227642276422765%\"\u003e\n \u003cp\u003e27.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.821138211382113%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.634146341463415%\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.634146341463415%\"\u003e\n \u003cp\u003e28.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.479674796747968%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.788617886178862%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.227642276422765%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.821138211382113%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.634146341463415%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.414634146341463%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.634146341463415%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Anthropometry measurements of children\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"22.02283849918434%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnthropometry measurements\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"20.880913539967374%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclinical Hypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"22.838499184339316%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"22.512234910277325%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEuthyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"11.745513866231647%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.995073891625616%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.532019704433498%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.748768472906406%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.733990147783253%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25615763546798%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.733990147783253%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.02283849918434%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHeight (cms)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.256117455138662%\"\u003e\n \u003cp\u003e105.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.624796084828711%\"\u003e\n \u003cp\u003e15.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.092985318107667%\"\u003e\n \u003cp\u003e102.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.745513866231647%\"\u003e\n \u003cp\u003e24.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.766721044045678%\"\u003e\n \u003cp\u003e105.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.745513866231647%\"\u003e\n \u003cp\u003e16.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"11.745513866231647%\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.953789279112755%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight (kgs)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.754158964879853%\"\u003e\n \u003cp\u003e16.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.905730129390019%\"\u003e\n \u003cp\u003e6.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.569316081330868%\"\u003e\n \u003cp\u003e15.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.308687615526802%\"\u003e\n \u003cp\u003e6.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.199630314232902%\"\u003e\n \u003cp\u003e16.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.308687615526802%\"\u003e\n \u003cp\u003e6.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Distribution of children according to Age of Onset of Disease\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"22.333333333333332%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge of Onset of Disease (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"21.333333333333332%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclinical Hypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"23.333333333333332%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"23%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEuthyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"10%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.285714285714286%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.24137931034483%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.748768472906406%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.733990147783253%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.25615763546798%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.733990147783253%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.333333333333332%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.666666666666666%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.666666666666666%\"\u003e\n \u003cp\u003e45.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.333333333333334%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12%\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12%\"\u003e\n \u003cp\u003e36.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" width=\"10%\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.814814814814813%\"\u003e\n \u003cp\u003e\u003cstrong\u003e1-3 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74074074074074%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003e36.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.592592592592593%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.222222222222221%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\"\u003e\n \u003cp\u003e42.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.814814814814813%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;3 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74074074074074%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003e18.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.592592592592593%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.222222222222221%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\"\u003e\n \u003cp\u003e21.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.814814814814813%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.74074074074074%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.962962962962964%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.592592592592593%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.222222222222221%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.333333333333334%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.814814814814813%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"23.703703703703702%\"\u003e\n \u003cp\u003e3.71 \u0026plusmn; 2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"25.925925925925927%\"\u003e\n \u003cp\u003e4.38 \u0026plusmn; 3.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"25.555555555555557%\"\u003e\n \u003cp\u003e3.69 \u0026plusmn; 2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6: Distribution of children according to Family History of Thyroid Dysfunction\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"29.896907216494846%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily History of Thyroid Dysfunction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"20.446735395189002%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclinical Hypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"19.759450171821307%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"19.587628865979383%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEuthyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"10.309278350515465%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.832853025936599%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.172910662824208%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.121037463976945%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.020172910662826%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.832853025936599%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.020172910662826%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.948364888123923%\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.261617900172118%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.433734939759036%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.359724612736661%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.261617900172118%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.359724612736661%\"\u003e\n \u003cp\u003e5.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"10.327022375215146%\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.397312859884835%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.213051823416507%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.435700575815739%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.404990403071018%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.667946257197697%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.213051823416507%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.667946257197697%\"\u003e\n \u003cp\u003e94.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.397312859884835%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.213051823416507%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.435700575815739%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.404990403071018%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.667946257197697%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.213051823416507%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.667946257197697%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.948364888123923%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.261617900172118%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.048192771084338%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.433734939759036%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.359724612736661%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.261617900172118%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.359724612736661%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.327022375215146%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7: Distribution of children according to Clinical Presentation\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"27.659574468085108%\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Presentation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"21.099290780141843%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclinical Hypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"20.390070921985817%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"20.21276595744681%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEuthyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"10.638297872340425%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.832853025936599%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.172910662824208%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.121037463976945%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.020172910662826%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.832853025936599%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.020172910662826%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.708703374777976%\"\u003e\n \u003cp\u003e\u003cstrong\u003eConstipation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.52575488454707%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.433392539964476%\"\u003e\n \u003cp\u003e4.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.703374777975133%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.72291296625222%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.52575488454707%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.72291296625222%\"\u003e\n \u003cp\u003e5.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"10.657193605683837%\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.013916500994036%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSensitivity to Cold / Dry Skin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.542743538767395%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.916500994035784%\"\u003e\n \u003cp\u003e9.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.74155069582505%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.121272365805169%\"\u003e\n \u003cp\u003e16.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.542743538767395%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.121272365805169%\"\u003e\n \u003cp\u003e7.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8: Distribution of children according to Treatment History\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"36%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment History\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"19%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclinical Hypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"18.166666666666668%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"16.833333333333332%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEuthyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"10%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.666666666666668%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.51851851851852%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.271604938271604%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.37037037037037%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.654320987654321%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.51851851851852%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnti HTN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e77.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.166666666666667%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11%\"\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.833333333333333%\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e78.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" width=\"10%\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEPO Injection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e81.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.962962962962963%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.222222222222221%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.592592592592593%\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e81.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIron Supplementation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e95.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.962962962962963%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.222222222222221%\"\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.592592592592593%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e94.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCalcium Supplementation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.962962962962963%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.222222222222221%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.592592592592593%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9: Distribution of children according to Proteinuric CKD\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"margin-right: calc(2%); width: 98%;\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 28.625%;\" width=\"30.01715265866209%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"20.41166380789022%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclinical Hypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"19.725557461406517%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"19.554030874785592%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEuthyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5%;\" width=\"10.291595197255575%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.832853025936599%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.172910662824208%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.121037463976945%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.020172910662826%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.832853025936599%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.020172910662826%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.625%;\" width=\"30.06872852233677%\"\u003e\n \u003cp\u003e\u003cstrong\u003eProteinuric CKD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.027491408934708%\"\u003e\n \u003cp\u003e18.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.419243986254296%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e16.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.24742268041237%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.34020618556701%\"\u003e\n \u003cp\u003e26.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 5%;\" width=\"10.309278350515465%\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.625%;\" width=\"33.524904214559385%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNon-Proteinuric CKD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.195402298850574%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.409961685823754%\"\u003e\n \u003cp\u003e81.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.386973180076629%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e83.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.195402298850574%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e73.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28.625%;\" width=\"33.524904214559385%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.195402298850574%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.409961685823754%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.386973180076629%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.195402298850574%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.64367816091954%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 10: Distribution of children according to Biochemical parameters\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"margin-right: calc(0%); width: 100%;\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"21.006944444444443%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiochemical parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"23.4375%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclinical Hypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"22.569444444444443%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"22.569444444444443%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEuthyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"10.416666666666666%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.243654822335024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.766497461928935%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.243654822335024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.751269035532996%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.243654822335024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.751269035532996%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.043478260869566%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBUN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.130434782608695%\"\u003e\n \u003cp\u003e46.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.173913043478262%\"\u003e\n \u003cp\u003e18.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.130434782608695%\"\u003e\n \u003cp\u003e38.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.478260869565217%\"\u003e\n \u003cp\u003e15.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.130434782608695%\"\u003e\n \u003cp\u003e48.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.478260869565217%\"\u003e\n \u003cp\u003e19.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" width=\"10.434782608695652%\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.49514563106796%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCreatinine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.427184466019417%\"\u003e\n \u003cp\u003e3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.592233009708737%\"\u003e\n \u003cp\u003e2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.427184466019417%\"\u003e\n \u003cp\u003e4.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.815533980582524%\"\u003e\n \u003cp\u003e1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.427184466019417%\"\u003e\n \u003cp\u003e3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.815533980582524%\"\u003e\n \u003cp\u003e2.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.49514563106796%\"\u003e\n \u003cp\u003e\u003cstrong\u003eeGFR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.427184466019417%\"\u003e\n \u003cp\u003e21.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.592233009708737%\"\u003e\n \u003cp\u003e12.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.427184466019417%\"\u003e\n \u003cp\u003e22.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.815533980582524%\"\u003e\n \u003cp\u003e21.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.427184466019417%\"\u003e\n \u003cp\u003e21.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.815533980582524%\"\u003e\n \u003cp\u003e12.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 11: Correlation of CKD Stage with Thyroid function of children\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"22.873345935727787%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCKD Stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"22.495274102079396%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclinical Hypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"21.73913043478261%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypothyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"21.550094517958414%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEuthyroid\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"11.342155009451796%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"13.832853025936599%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.172910662824208%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.121037463976945%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.020172910662826%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.832853025936599%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.020172910662826%\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.916666666666668%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.257575757575758%\"\u003e\n \u003cp\u003e13.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.280303030303031%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e33.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.090909090909092%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e10.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" width=\"11.363636363636363%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.854700854700855%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage 4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.957264957264957%\"\u003e\n \u003cp\u003e45.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.47008547008547%\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.102564102564102%\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.102564102564102%\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.854700854700855%\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage 5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.957264957264957%\"\u003e\n \u003cp\u003e40.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.47008547008547%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.102564102564102%\"\u003e\n \u003cp\u003e66.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.102564102564102%\"\u003e\n \u003cp\u003e39.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.854700854700855%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.957264957264957%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.47008547008547%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.102564102564102%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.256410256410257%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.102564102564102%\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 12: Correlation of eGFR with thyroid function parameters\u003c/strong\u003e\u003c/p\u003e\n \u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"25.330812854442343%\"\u003e\n \u003cp\u003e\u003cstrong\u003eeGFR (ml/min/1.73m\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"25.519848771266542%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTSH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"24.574669187145556%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFT3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"24.574669187145556%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFT4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.243654822335024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.766497461928935%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.243654822335024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.751269035532996%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.243654822335024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.751269035532996%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.37878787878788%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\"\u003e\n \u003cp\u003e7.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.257575757575758%\"\u003e\n \u003cp\u003e4.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\"\u003e\n \u003cp\u003e2.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.37878787878788%\"\u003e\n \u003cp\u003e\u003cstrong\u003e15-30\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\"\u003e\n \u003cp\u003e4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.257575757575758%\"\u003e\n \u003cp\u003e2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\"\u003e\n \u003cp\u003e2.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.37878787878788%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;30\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\"\u003e\n \u003cp\u003e2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.257575757575758%\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\"\u003e\n \u003cp\u003e3.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.121212121212121%\"\u003e\n \u003cp\u003e1.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.330812854442343%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"25.519848771266542%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"24.574669187145556%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" width=\"24.574669187145556%\"\u003e\n \u003cp\u003e\u0026gt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Graphs","content":"\u003cp\u003eGraph 1 to 12 is available in Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"subclinical hypothyroidism, chronic kidney disease","lastPublishedDoi":"10.21203/rs.3.rs-1761891/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1761891/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Nephro-endocrine association has been known for a long time. The kidney contributes to clearance of iodine primarily by glomerular filtration. As iodine excretion is diminished in advanced renal failure, leading to an elevated plasma inorganic iodide concentration and initial increment in throidal iodide uptake. Increased total body iodide can potentially block thyroid hormone production by affecting the pituitary-thyroid axis and peripheral metabolism of thyroid hormone .So, thyroid dysfunction is commonly seen endocrine abnormality among CKD patients. A hospital based prospective observational study was conducted with 66 children to assess the prevalence of abnormal thyroid functions in children with chronic kidney disease and to correlate abnormal thyroid functions with different etiologies of chronic kidney disease and different stages of chronic kidney disease. It has been shown that in CKD, as the GFR falls there is a higher possibility of developing clinical and subclinical hypothyroidism.","manuscriptTitle":"Prospective study of thyroid functions in children with chronic kidney disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-07-01 14:34:49","doi":"10.21203/rs.3.rs-1761891/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"68059630-8561-4398-b2b2-0a207b0300e1","owner":[],"postedDate":"July 1st, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-07-01T14:34:50+00:00","versionOfRecord":[],"versionCreatedAt":"2022-07-01 14:34:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1761891","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1761891","identity":"rs-1761891","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}