Serum thyrotrophin at baseline predicts the natural course of subclinical hyperthyroidism
Serum thyrotrophin at baseline predicts the natural course of subclinical hyperthyroidism
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DOI：
10.1111/j.1365-2265.2012.04345.x
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发表时间：
2012-07-01
影响因子：
3.2
通讯作者：
Okosieme, O. E.
中科院分区：
文献类型：
--
作者：
Das, G.;Ojewuyi, T. A.;Okosieme, O. E.
目的亚临床甲亢的最佳治疗策略尚未确定。显性疾病发生在少数病例中，但进展的危险因素尚不清楚。我们研究了在无症状的亚临床甲亢患者中，基线促甲状腺激素(TSH)是否预示着发展为显性甲亢。设计、患者和测量本研究对2003-2010年间收治的323例亚临床甲亢患者进行了回顾性研究，平均年龄71岁，男性26.9%，女性73.1%，平均随访时间32个月，范围693个月。在基线和随访期间记录血清TSH和游离甲状腺激素(FT4)。在排除非甲状腺原因的低TSH患者后，按初始TSH分组：TSH0.100.39mU/L(I级)和TSH0.10mU/L(II级)。结果显性甲亢38例(11.8%)，年进展率0.63.7%。大多数患者甲状腺功能恢复正常(31.6%)或仍处于亚临床甲亢状态(56.7%)。II级患者进展为坦率甲亢的比例高于I级患者(20.3%比6.8%，P<；0.001，卡方检验)。Kaplan-Meier曲线显示II级的进展速度快于I级(P<；0.001，对数等级检验)。多因素逐步COX回归分析显示，TSH+lt；0.1mU/L与临床甲亢有关(危险比3.4，可信区间1.67.0)，而年龄、性别、FT4和病因诊断与甲亢无关。结论促甲状腺激素可预测无症状亚临床甲状腺功能亢进症患者的甲亢。TSH+lt；0.10mU/L患者进展为甲状腺功能亢进症的风险高于TSH0.100.39mU/L。
Objective Optimal therapeutic strategies for subclinical hyperthyroidism are undecided. Overt disease develops in a minority of cases, but the risk factors for progression remain unclear. We examined whether a baseline thyrotrophin (TSH) predicted progression to overt hyperthyroidism in asymptomatic individuals with subclinical hyperthyroidism. Design, patients and measurements This was a retrospective study of 323 patients with subclinical hyperthyroidism seen in our institution from 2003 to 2010 (mean age 71 years, males 26.9%, females 73.1%, mean follow-up duration 32 months, range 693 months). Serum TSH and free thyroxine (FT4) were documented at baseline and during follow-up. After excluding individuals with nonthyroid causes of low TSH, patients were grouped according to initial TSH as: TSH 0.100.39 mU/l (grade I) and TSH < 0.10 mU/l (grade II). Results Only 38 patients (11.8%) developed overt hyperthyroidism with annual progression rates of 0.63.7%. Most patients reverted to normal thyroid status (31.6%) or remained subclinically hyperthyroid (56.7%). Progression to frank hyperthyroidism was higher in grade II than in grade I patients (20.3% vs 6.8%, P < 0.001, Chi square test). KaplanMeier curves showed faster progression rates in grade II than grade I (P < 0.001, log rank test). In stepwise multivariate Cox regression analysis, TSH < 0.1 mU/l was associated with overt hyperthyroidism (hazard ratio 3.4, confidence interval 1.67.0), whereas age, gender, FT4 and aetiological diagnosis were not associated with hyperthyroidism. Conclusions Thyrotrophin predicts overt hyperthyroidism in asymptomatic individuals with subclinical hyperthyroidism. Patients with TSH < 0.10 mU/l have a higher risk of progressing to hyperthyroidism than those with TSH 0.100.39 mU/l.