{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:24:06Z","timestamp":1787657046594,"version":"build-2736575974"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Advanced chronic kidney disease and kidney failure frequently produce thyroid-test patterns that resemble primary hypothyroidism. The clinical challenge is not to dismiss abnormal results, but to distinguish persistent, treatment-requiring thyroid failure from uraemic, non-thyroidal, volume-related, medication-related, and analytical mimics before committing a vulnerable patient to long-term levothyroxine. This structured, evidence-informed narrative review critically appraises epidemiology, dialysis-specific sampling studies, prognostic cohorts, treatment evidence, and major thyroid guidance. Low triiodothyronine is consistently associated with inflammation, protein-energy wasting, and adverse outcomes, but currently functions chiefly as a prognostic and illness-severity signal rather than a replacement target. For clinically stable patients without a red flag, we propose repeat thyroid-stimulating hormone and free-thyroxine testing after optimisation of volume status and systemic illness, at a consistent point in the dialysis cycle, with review of iodine exposure, medicines, absorption, and assay interference. General-population thresholds for subclinical hypothyroidism may inform, but cannot replace, contextual judgement because no chronic-kidney-disease- or dialysis-specific diagnostic or treatment threshold has been prospectively validated. Prompt treatment or endocrinology input remains appropriate for myxoedema coma, central hypothyroidism, pregnancy or pregnancy planning, known permanent hypothyroidism, and a persistent overt primary pattern. The goal is diagnostic precision: timely levothyroxine for patients most likely to benefit and avoidance of premature long-term replacement for reversible mimicry.<\/jats:p>","DOI":"10.1093\/joneph\/aajag230","type":"journal-article","created":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T11:45:08Z","timestamp":1787399108000},"source":"Crossref","is-referenced-by-count":0,"title":["Thyroid tests in kidney failure: diagnostic stewardship before levothyroxine therapy"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6851-1542","authenticated-orcid":false,"given":"Yoshitaka","family":"Furuto","sequence":"first","affiliation":[{"name":"Department of Hypertension and Nephrology, NTT Medical Center Tokyo , 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiki","family":"Yoshino","sequence":"additional","affiliation":[{"name":"Department of Hypertension and Nephrology, NTT Medical Center Tokyo , 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akio","family":"Namikawa","sequence":"additional","affiliation":[{"name":"Department of Hypertension and Nephrology, NTT Medical Center Tokyo , 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dai","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Hypertension and Nephrology, NTT Medical Center Tokyo , 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuko","family":"Shibuya","sequence":"additional","affiliation":[{"name":"Department of Hypertension and Nephrology, NTT Medical Center Tokyo , 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo 141-8625 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,25]]},"container-title":["Journal of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/joneph\/advance-article-pdf\/doi\/10.1093\/joneph\/aajag230\/70783507\/aajag230.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/joneph\/advance-article-pdf\/doi\/10.1093\/joneph\/aajag230\/70783507\/aajag230.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T11:11:56Z","timestamp":1787656316000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/joneph\/advance-article\/doi\/10.1093\/joneph\/aajag230\/8770269"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,25]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/joneph\/aajag230","relation":{},"ISSN":["1121-8428","1724-6059"],"issn-type":[{"value":"1121-8428","type":"print"},{"value":"1724-6059","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,25]]},"article-number":"aajag230"}}