Natural History of Thyroid Function Tests over 5 Years in a Large Pediatric Cohort
Natural History of Thyroid Function Tests over 5 Years in a Large Pediatric Cohort
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DOI：
10.1210/jc.2008-2615
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发表时间：
2009-05-01
影响因子：
5.8
通讯作者：
Meyerovitch, Joseph
中科院分区：
文献类型：
--
作者：
Lazar, Liora;Frumkin, Rachel Ben-David;Meyerovitch, Joseph
内容：由于甲状腺疾病的临床表现在儿童和青少年中是可变的和微妙的，甲状腺功能检查经常在具有非特异性症状的患者中重复进行。目的：本研究的目的是确定初始异常TSH的自然史，并确定发生随后甲状腺功能障碍的风险更大的人群。方法：2002年和2007年随访期间，Clalit健康医疗组织承保的104.3万名0.5-16岁门诊患者中共有121,052人接受了TSH测定。从Clalit健康医疗组织数据库中提取的是他们的人口统计数据、转诊诊断和实验室结果（TSH、游离T-4、甲状腺抗体）。结果：96.5%的初测血清TSH浓度正常（0.35- 5.5mIU/L），0.2%的初测血清TSH浓度偏低（5.5 ~ 10 mIU/L）。TSH检测的频率随着年龄和女性性别的增加而增加。在随访期间，45.7%的患者进行了重复（两次至四次以上）TSH检测。在第二次TSH测定中，在初始血清TSH高度升高、升高和降低的患者中，分别有40%、73.6%和78.9%的患者TSH正常，而在初始TSH正常的患者中，有97%的患者TSH正常。持续高度升高的TSH的预测因素是初始TSH大于7.5 mIU/L（P = 0.014）和女性性别（P = 0.047）。结论：在儿科人群中，初始正常或轻度升高的TSH水平可能保持正常或自发正常化，无需治疗。初始水平大于7.5 mIU/L的患者，特别是女孩，持续异常TSH水平的风险更大。（临床内分泌代谢杂志94：1678-1682，2009）
Context: Because clinical manifestations of thyroid disorders are variable and subtle in children and adolescents, thyroid function tests are often repeated in patients with nonspecific symptoms.Objectives: The objective of the study was to determine the natural history of initial abnormal TSH and define populations at greater risk for developing a subsequent thyroid dysfunction.Methods: A total of 121,052 of 1.043 million outpatients aged 0.5-16 yr insured by the Clalit Health Medical Organization had a TSH determination in 2002 and follow-up to 2007. Extracted from the Clalit Health Medical Organization database were their demographic data, referral diagnoses, and laboratory results (TSH, free T-4, thyroid antibodies). Excluded were patients with overt hypothyroidism or hyperthyroidism on initial testing.Results: Results of 96.5% of initial serum TSH concentrations were normal (0.35-5.5 mIU/liter), 0.2% were low (5.5 to 10 mIU/liter). The frequency of TSH testing increased with age and female gender. During follow-up, repeated (two to more than four) TSH tests were performed in 45.7% of the patients. In the second TSH determination, normal TSH was documented in 40, 73.6, and 78.9% of those whose initial serum TSH was highly elevated, elevated, and low, respectively, and in 97% of those with normal initial TSH. Predictive factors for a sustained highly elevated TSH were initial TSH greater than 7.5 mIU/liter (P = 0.014) and female gender (P = 0.047).Conclusions: In the pediatric population, initial normal or slightly elevated TSH levels are likely to remain normal or spontaneously normalize without treatment. Patients with initial levels greater than 7.5 mIU/liter, particularly girls, are at a greater risk for sustained abnormal TSH levels. (J Clin Endocrinol Metab 94: 1678-1682, 2009)