Thyrotropin and Thyroid Antibodies as Predictors of Hypothyroidism: A 13-Year, Longitudinal Study of a Community-Based Cohort Using Current Immunoassay Techniques
Thyrotropin and Thyroid Antibodies as Predictors of Hypothyroidism: A 13-Year, Longitudinal Study of a Community-Based Cohort Using Current Immunoassay Techniques
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DOI：
10.1210/jc.2009-1977
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发表时间：
2010-03-01
影响因子：
5.8
通讯作者：
O'Leary, Peter
中科院分区：
文献类型：
--
作者：
Walsh, John P.;Bremner, Alexandra P.;O'Leary, Peter
背景：需要对甲状腺功能减退症的危险因素进行纵向研究，以告知关于TSH参考范围的争论。有有限的纵向数据的预测价值的甲状腺抗体测定的自动免疫分析（相对于半定量方法）。方法：我们测量TSH，游离T-4，甲状腺过氧化物酶抗体（TPOAbs），甲状腺球蛋白抗体（TgAbs）使用Immulite平台的血清从1184名参与者在1981年和1994年布塞尔顿健康调查。随访时的结局指标为甲状腺功能减退症，定义为TSH大于4.0 mU/L或接受甲状腺素治疗;明显甲状腺功能减退症，定义为TSH大于10.0 mU/L或接受甲状腺素治疗。接收器操作员的特征分析被用来确定最佳截止基线TSH，TPOAbs，TgAbs作为甲状腺功能减退症的预测。结果：在13年的随访，110名受试者（84名妇女）有甲状腺功能减退症，其中42（38名妇女）有明显的甲状腺功能减退症。预测甲状腺功能减退的最佳临界值是基线TSH高于2.5 mU/L，TPOAbs高于29 kIU/L，TgAbs高于22 kIU/L，而参考范围上限分别为4.0 mU/L，35 kIU/L和55 kIU/L。在甲状腺抗体阳性的女性中（TPOAb或TgAb），随访时甲状腺功能减退症的患病率（95%置信区间）为12.0%当基线TSH ≤ 2.5 mU/L时（3.0-21.0%），TSH在2.5 - 4.0 mU/L之间的患者为37.1-73.3%，（74.1-97.3%）的TSH高于4.0 mU/L。使用2.5和4.0 mU/L的TSH临界值，结合甲状腺抗体，提供了一个临床有用的估计甲状腺功能减退症的长期风险。（临床内分泌代谢杂志95：1095-1104，2010）
Context: Longitudinal studies of risk factors for hypothyroidism are required to inform debate regarding the TSH reference range. There are limited longitudinal data on the predictive value of thyroid antibodies measured by automated immunoassay (as opposed to semiquantitative methods).Methods: We measured TSH, free T-4, thyroid peroxidase antibodies (TPOAbs), and thyroglobulin antibodies (TgAbs) using the Immulite platform on sera from 1184 participants in the 1981 and 1994 Busselton Health Surveys. Outcome measures at follow-up were hypothyroidism, defined as TSH greater than 4.0 mU/liter or on thyroxine treatment; and overt hypothyroidism, defined as TSH above 10.0 mU/liter or on thyroxine treatment. Receiver-operator characteristic analysis was used to determine optimal cutoffs for baseline TSH, TPOAbs, and TgAbs as predictors of hypothyroidism.Results: At 13 yr follow-up, 110 subjects (84 women) had hypothyroidism, of whom 42 (38 women) had overt hypothyroidism. Optimal cutoffs for predicting hypothyroidism were baseline TSH above 2.5 mU/liter, TPOAbs above 29 kIU/liter, and TgAbs above 22 kIU/liter, compared with reference range upper limits of 4.0 mU/liter, 35 kIU/liter, and 55 kIU/liter, respectively. In women with positive thyroid antibodies (TPOAbs or TgAbs), the prevalence of hypothyroidism at follow-up (with 95% confidence intervals) was 12.0% (3.0-21.0%) when baseline TSH was 2.5 mU/liter or less, 55.2% (37.1-73.3%) for TSH between 2.5 and 4.0 mU/liter, and 85.7% (74.1-97.3%) for TSH above 4.0 mU/liter.Conclusions: The use of TSH cutoffs of 2.5 and 4.0 mU/liter, combined with thyroid antibodies, provides a clinically useful estimate of the long-term risk of hypothyroidism. (J Clin Endocrinol Metab 95: 1095-1104, 2010)