Effect of Seasonal Changes on the Transition Between Subclinical Hypothyroid and Euthyroid Status
Effect of Seasonal Changes on the Transition Between Subclinical Hypothyroid and Euthyroid Status
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DOI：
10.1210/jc.2013-1607
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发表时间：
2013-08-01
影响因子：
5.8
通讯作者：
Park, Young Joo
中科院分区：
文献类型：
--
作者：
Kim, Tae Hyuk;Kim, Kyung Won;Park, Young Joo
背景：在无症状个体中广泛使用甲状腺检测可识别出许多患有暂时性亚临床甲状腺功能减退症的患者。目的：我们的目的是确定季节变化对血清 TSH 水平的影响以及亚临床甲状腺功能减退症和甲状腺功能正常状态之间的转变。设计、背景和受试者：这是一项针对 1751 名亚临床甲状腺功能减退症患者的回顾性纵向研究 2003年10月至2011年5月期间在健康筛查中心接受系列甲状腺功能检查的28 096名18岁以上甲状腺功能正常受试者。 主要指标：采用线性混合模型计算年龄调整后的每月TSH水平几何平均值。使用广义估计方程确定测试季节和多个基线临床因素的调整优势比。结果：在中位 36 个月的随访期间，57.9% 的亚临床甲状腺功能减退受试者恢复甲状腺功能正常，4.3% 的甲状腺功能正常受试者出现亚临床甲状腺功能减退。随访TSH水平的每月分布呈现双相模式，即冬春季节升高，夏秋季节降低，亚临床甲减受试者TSH最大差异为0.69 mIU/L，甲状腺功能正常受试者TSH最大差异为0.30 mIU/L。在夏季-秋季随访期间的随访测试中，亚临床甲状腺功能减退症的正常化程度增加了 1.4 倍，而甲状腺功能正常的受试者在冬春随访期间，亚临床甲状腺功能减退症的正常化程度增加了 1.4 倍。 结论：进行甲状腺检查的季节与亚临床甲状腺功能减退症和甲状腺功能正常状态之间的转变独立相关。在决定治疗亚临床甲状腺功能减退症之前，应考虑 TSH 浓度的季节性变化，特别是在年温差较大的地区。
Context: The widespread use of thyroid tests in asymptomatic individuals identifies many patients with transient subclinical hypothyroidism.Objective: Our objective was to determine the effect of seasonal change on serum TSH levels and the transition between subclinical hypothyroid and euthyroid status.Design, Setting, and Subjects: This was a retrospective longitudinal study of 1751 subclinical hypothyroid and 28 096 euthyroid subjects aged over 18 years who underwent serial thyroid function tests at a health screening center between October 2003 and May 2011.Main Outcome Measures: Age-adjusted geometric mean values of the TSH level by month were calculated using linear mixed models. Adjusted odds ratios of test season and multiple baseline clinical factors were determined using generalized estimating equations.Results: During a median 36 months of follow-up, 57.9% of subclinical hypothyroid subjects reverted to euthyroidism, and 4.3% of euthyroid subjects developed subclinical hypothyroidism. The monthly distribution of follow-up TSH levels indicated a biphasic pattern, ie, an increase during the winter-spring season and a decrease during the summer-fall season, with a maximal TSH difference of 0.69 mIU/L in subclinical hypothyroid and 0.30 mIU/L in euthyroid subjects. Normalization of subclinical hypothyroidism was increased 1.4-fold in follow-up tests during the summer-fall follow-up, whereas subclinical hypothyroidism increased 1.4-fold in euthyroid subjects during the winterspring follow-up.Conclusions: The season in which thyroid testing was performed was independently related to the transition between subclinical hypothyroid and euthyroid status. Seasonal variations in TSH concentration should be considered before deciding on treatment of subclinical hypothyroidism, particularly in the areas with a wide annual temperature range.