Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients
Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients
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DOI：
10.1210/jc.85.12.4701
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发表时间：
2000-12-01
影响因子：
5.8
通讯作者：
Perticone, F
中科院分区：
文献类型：
--
作者：
Biondi, B;Palmieri, EA;Perticone, F
为了确定内源性亚临床甲状腺功能亢进症的临床影响，使用症状评定量表和简明健康调查问卷对23例患者（3例男性和20例女性;平均年龄43 ± 9岁）和23例年龄、性别和生活方式匹配的正常受试者的甲状腺激素过多的具体症状和体征以及生活质量进行了评估。由于心脏是甲状腺激素的主要靶器官之一，因此还通过标准12导联心电图（ECG）、24 h Wolter EGG和完全多普勒超声心动图研究了心脏形态和功能。在研究前至少6个月，所有患者均被诊断为稳定的内源性亚临床甲状腺功能亢进症（TSH，0.15 +/- 0.1 mU/L;游离T（3），6.9 +/- 1.1，pmol/L;游离T（4），17.2 +/- 2.3，pmol/L）。15例患者患有多结节性甲状腺肿，8例患者患有自主功能性甲状腺结节。平均症状评定量表评分（9.8 +/- 5.5 vs. 4.3 +/- 2.2，P < 0.001）（36.1 ± 9.5 vs. 50.0 ± 8.5，P < 0.001）和身体（42.6 +/- 8.0 vs. 55.6 +/- 4.1，简明健康调查表36的组成部分评分（P < 0.001）记录了甲状腺激素过多的特定症状和体征的显著患病率以及患者生活质量的显著损害。霍尔特心电图显示内源性亚临床甲亢患者房性早搏发生率高于对照组，但差异无统计学意义，但平均心率明显增加（P < 0.001）。左室质量增加（162 ± 24 vs. 132，22 g，P < 0.001），原因是室间隔（P = 0.025）和后壁（P = 0.004）厚度增加。患者的收缩功能增强，表现为缩短分数（P = 0.005）和心率调整的环周纤维缩短平均速度（P = 0.036）的显著增加。舒张功能的多普勒参数明显受损，表现为二尖瓣血流速度早/晚比值降低（P < 0.001）和等容舒张时间延长（P = 0.006），提示内源性亚临床甲亢对心脏形态和功能有一定的影响。此外，他们建议，在年轻和中年患者中也应考虑治疗持续性内源性亚临床甲状腺功能亢进症，以减轻甲状腺激素过量的特定症状和体征，改善生活质量，并避免长期暴露于轻度过量的甲状腺激素对心脏造成的后果。
To determine the clinical impact of endogenous subclinical hyperthyroidism, specific symptoms and signs of thyroid hormone excess and quality of life were assessed in 23 patients (3 males and 20 females; mean age, 43 +/- 9 yr) and 23 age-, sex-, and lifestyle-matched normal subjects by using the Symptoms Rating Scale and the Short Form 36 Health Survey questionnaires. Because the heart is one of the main target organs of the thyroid hormone, cardiac morphology and function were also investigated by means of standard 12-lead electrocardiogram (ECG), 24-h Wolter EGG, and complete Doppler echocardiography. Stable endogenous subclinical hyperthyroidism had been diagnosed in all patients at least 6 months before the study (TSH, 0.15 +/- 0.1 mU/L; free T(3), 6.9 +/- 1.1, pmol/L; free T(4), 17.2 +/- 2.3, pmol/L). Fifteen patients were affected by multinodular goiter, and eight patients by autonomously functioning thyroid nodule. The mean Symptoms Rating Scale score (9.8 +/- 5.5 vs. 4.3 +/- 2.2, P < 0.001) and both the mental (36.1 +/- 9.5 vs. 50.0 +/- 8.5, P < 0.001) and physical (42.6 +/- 8.0 vs. 55.6 +/- 4.1, P < 0.001) component scores of Short Form 36 Health Survey documented a significant prevalence of specific symptoms and signs of thyroid hormone excess and notable impairment of quality of life in patients. Holter ECG showed a higher prevalence of atrial premature beats in endogenous subclinical hyperthyroid patients than in the controls, but the difference was not statistically significant, although the average heart rate was significantly increased in the patients (P < 0.001). An increase of left ventricular mass (162 +/- 24 vs. 132, 22 g, P < 0.001) due to the increase of septal (P = 0.025) and posterior wall (P = 0.004) thickness was observed in patients. Systolic function was enhanced in patients as shown by the significant increase of both fractional shortening (P = 0.005) and mean velocity of heart rate-adjusted circumferential fiber shortening (P = 0.036). The Doppler parameters of diastolic function were significantly impaired in the patients as documented by the reduced early to late ratio of the transmitral flow Velocities (P < 0.001) and the prolonged isovolumic relaxation time (P = 0.006).These data indicate that endogenous subclinical hyperthyroidism has a relevant clinical impact and that it affects cardiac morphology and function. Moreover, they suggest that treatment of persistent endogenous subclinical hyperthyroidism should be considered also in young and middle-aged patients to attenuate specific symptoms and signs of thyroid hormone excess, ameliorate the quality of life, and avoid the consequences to the heart of long exposure to a mild excess of thyroid hormone.