The Etiology of Abnormal TSH in Veterans Cared by a VA Medical Center - One High Serum Thyrotropin is Associated with Higher 5-Years Mortality.
The Etiology of Abnormal TSH in Veterans Cared by a VA Medical Center - One High Serum Thyrotropin is Associated with Higher 5-Years Mortality.
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由VA医疗中心照顾的退伍军人中TSH异常的病因 - 一种高血清甲状腺蛋白质与较高的5年死亡率有关。
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发表时间：
2023-03
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通讯作者：
Zhao H
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作者：
Wu SY;Chambers M;Khan M;Chinweze M;Cao TM;Zhao H
通过分析随机选择的退伍军人患者的TSH异常的病因，我们将我们的心放在改善未来的临床护理/管理的临床/亚临床甲状腺功能亢进症和甲状腺功能减退症的老龄化退伍军人人口。共选择了1100例患者的病历，按字母顺序排列。排除信息不充分的病例，对897例患者的病历进行了回顾和分析，以了解TSH异常的原因。其中低TSH（<0.55 uU/mL）602例，高TSH（> 4.78 uU/mL）295例。在所选的1100例患者中，680例（61.8%）为60岁或以上（女性=44，6.8%）; 420例为60岁以下（女性=80，19.0%）;年轻年龄组中女性患者明显更多（P<0.001）。排除数据不足的患者后，TSH抑制的最常见原因是碘诱导的，CT碘造影剂和聚维酮碘的使用在老年组（n=126）中占35.0%，而在年轻组（n=57）中占23.6%（P = 0.027）。显著性差异是老年退伍军人接受了更多的对比CT检查（与年轻组相比P < 0.05）。在两个年龄组同时进行的FT 4研究中，我们发现90项研究中有4项FT 4升高，4.4%为显性甲亢。TSH抑制的第二个最常见原因是年龄> 60岁的老年组（119例，33.1%）的甲状腺激素（TH）替代，与年轻组相比明显更常见，P<0.001。17例甲状腺癌患者在甲状腺全切除术后接受TSH抑制治疗，明显的甲状腺功能亢进（27.8/%）明显高于碘负荷引起的TSH抑制（P<0.001）。在295例TSH升高的患者中，高TSH最常见的原因是由于T4替代的甲状腺功能减退症：老年组（N=216）中共有128例（59.3%），与年轻组（N=79）中的47例（59.5%）相似。在两个年龄组中，有139例患者同时进行FT 4测量;发现17例明显的甲状腺功能减退症，占12.2%。两个年龄组之间没有显著差异。TSH升高的第二常见原因是CT造影剂输注，老年组23例（10.6%），年轻组7例（8.9%）。我们发现，在5年随访（从2016年到2021年）中，高TSH与101/238（42.4%）的较高死亡率相关，而在老年组中，低TSH为68/238（28.6%），p<0.03;两者均显著高于年龄和性别匹配的一般美国人群，19.7%，P<0.01。尽管大多数（约90%）是亚临床的，但TSH抑制和升高与老年退伍军人CV/CNS和免疫抑制并发症的严重后果相关。因此，建议在老年退伍军人中谨慎使用TH替代品和CT造影剂（并更频繁地检查TSH）。TSH升高的老年患者5年死亡率的惊人增加值得进一步研究。
By analyzing the etiology of abnormal TSH in randomly selected veteran patients, we set our heart on improving future clinical care/management of the clinical/subclinical hyper- and hypothyroidism in the aging veteran population. A total of 1100 patients’ charts in alphabetical order were selected. Excluded cases of insufficient information, 897 patients’ charts were reviewed and analyzed for causes of abnormal TSH. Among them, 602 for the cause of low TSH (below 0.55 uU/mL) and 295 for high TSH (above 4.78 uU/mL) were reviewed retrospectively. Among the 1100 patients selected, 680 (61.8%) were 60 y or older (female=44, 6.8%); 420 were under 60 y (female=80, 19.0%); significantly more female patients were found in the younger age group (P<0.001). After excluding patients with insufficient data, the most common cause of suppressed TSH is iodine-induced, CT iodinated contrast and betadine use caused 35.0% in the older group (n=126) compared to 23.6% in the younger group(n=57) (P = 0.027). The significant difference is that older veterans received more contrast CTs (P < 0.05 compared to the younger group). In both age groups with concurrent FT4 study, we found four high FT4 among 90 studies, 4.4% overt hyperthyroidism. The second most common cause of suppressed TSH is due to thyroid hormone (TH) replacement in the older group (119 patients, 33.1%) with age > 60y, significantly more frequent compared to the younger group, P<0.001. There is significantly more overt hyperthyroidism, 27.8/%, than the iodine-load induced suppression of TSH, P<0.001, due to 17 patients on TSH suppression therapy after total thyroidectomy for thyroid cancer. Among the 295 patients with elevated TSH, the most common cause of high TSH was due to hypothyroidism on T4 replacement: a total of 128 (59.3%) in the older group (N=216) is, similar to 47 (59.5%) in the younger group (N=79). In both age groups, there were 139 patients with concomitant FT4 measurement; 17 overt hypothyroidism were found, 12.2%. No significant difference is seen in the two age groups. The next most common causes of elevated TSH are CT contrast infusion, 23 (10.6%) in the older group and 7 (8.9%) in the younger group. We find high TSH is associated with a higher death rate of 101/238 (42.4%) in a 5-year follow-up (from 2016 to 2021), as compared to low TSH of 68/238 (28.6%), in the older age group, p<0.03； both were significantly higher than the age- and sex-matched general US population, 19.7%, P<0.01. Even though most, ~ 90%, were subclinical, the suppressed and elevated TSH are associated with severe consequences in CV/CNS and immune-suppression complications in aging veterans. Therefore, cautious use (and more frequent check of TSH) of TH replacement and CT contrast in aging veterans is recommended. The alarming increase in 5 years death rate in older patients with elevated TSH deserves further study.