Prevalence of subclinical thyroid dysfunction and its relation to socioeconomic deprivation in the elderly: a community-based cross-sectional survey

CONTEXT: Population-based screening has been advocated for subclinical thyroid dysfunction in the elderly because the disorder is perceived to be common, and health benefits may be accrued by detection and treatment. OBJECTIVE: The objective of the study was to determine the prevalence of subclinical thyroid dysfunction and unidentified overt thyroid dysfunction in an elderly population. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey of a community sample of participants aged 65 yr and older registered with 20 family practices in the United Kingdom. EXCLUSIONS: Exclusions included current therapy for thyroid disease, thyroid surgery, or treatment within 12 months. OUTCOME MEASURE: Tests of thyroid function (TSH concentration and free T4 concentration in all, with measurement of free T3 in those with low TSH) were conducted. EXPLANATORY VARIABLES: These included all current medical diagnoses and drug therapies, age, gender, and socioeconomic deprivation (Index of Multiple Deprivation, 2004). ANALYSIS: Standardized prevalence rates were analyzed. Logistic regression modeling was used to determine factors associated with the presence of subclinical thyroid dysfunction. RESULTS: A total of 5960 attended for screening. Using biochemical definitions, 94.2% [95% confidence interval (CI) 93.8-94.6%] were euthyroid. Unidentified overt hyper- and hypothyroidism were uncommon (0.3, 0.4%, respectively). Subclinical hyperthyroidism and hypothyroidism were identified with similar frequency (2.1%, 95% CI 1.8-2.3%; 2.9%, 95% CI 2.6-3.1%, respectively). Subclinical thyroid dysfunction was more common in females (P < 0.001) and with increasing age (P < 0.001). After allowing for comorbidities, concurrent drug therapies, age, and gender, an association between subclinical hyperthyroidism and a composite measure of socioeconomic deprivation remained. CONCLUSIONS: Undiagnosed overt thyroid dysfunction is uncommon. The prevalence of subclinical thyroid dysfunction is 5%. We have, for the first time, identified an independent association between the prevalence of subclinical thyroid dysfunction and deprivation that cannot be explained solely by the greater burden of chronic disease and/or consequent drug therapies in the deprived population.     

Socio demographic wise risk assessment of thyroid function abnormalities in far western region of Nepal: A hospital based descriptive study

Objective

To know the status of thyroid disorder in population of far western region of Nepal.

Methods

A total of 808 cases (133 men and 675 non pregnant women) were included and study was carried out using data retrieved from the register maintained in the Department of Biochemistry of the Nepalgunj Teaching Hospital between 1st January, 2011 and 28th February, 2012. The variables collected were age, sex, and thyroid function profile including free T3, free T4 and TSH.

Results

The percentage of thyroid disorders was 33.66% in far western region of Nepal. The people were highly affected by overt hyperthyroidism (14.9%) followed by subclinical hyperthyroidism (9.9%). The subclinical hypothyroidism was 7.9% while 1% overt hypothyroidism only in a far western region of Nepal. Females were highly affected by overt hyperthyroidism (17.8%), followed by subclinical hyperthyroidism (11.9%). A total of 5.9% females were affected by subclinical hypothyroidism while only 1.2% by overt hypothyroidism. Males were affected only by subclinical hypothyroidism (18.0%) in this present study. High number of total thyroid dysfunction was observed in 21 to 40 years of age groups, followed by 41 to 60 years of age groups. Less than 40 years people were having 1.03, 0.99, 2.51 and 1.15 times risk of developing overt hyperthyroidism, subclinical hyperthyroidism, overt hypothyroidism and subclinical hyperthyroidism respectively compared to greater than 40. Female were having 0.29 times risk of developing subclinical hyperthyroidism compared to male. But overt hyperthyroidism, subclinical hyperthyroidism and overt hypothyroidism female were having more risk of developing compared to male.

Conclusions

The thyroid disorder, especially overt hyperthyroidism (14.9%) and subclinical hyperthyroidism (9.9%) was high. Further studies are required to characterize the reasons for this high prevalence.     

Relationship of low-density lipoprotein (LDL) particle size to thyroid function status in Koreans

Objective  Dyslipidaemia is a well-known manifestation of thyroid dysfunction. Recently, small low-density lipoprotein (LDL) particle size has been linked with development of cardiovascular disease. To better understand the effects of thyroid dysfunction on the development of cardiovascular disease, we examined LDL particle size and lipid profiles in subjects with different thyroid function.
Methods  Included were 46 patients with overt hypothyroidism, 57 patients with subclinical hypothyroidism, 46 patients with overt hyperthyroidism, 51 patients with subclinical hyperthyroidism, and 110 age- and sex-matched healthy control subjects. We measured LDL particle size and lipid profiles in these subjects.
Results  No significant differences were found in LDL particle size between the groups with different thyroid function. Serum total cholesterol and LDL-cholesterol levels were significantly higher in the cases of hypothyroidism than in the cases of hyperthyroidism and the healthy control subjects. Serum triglyceride levels were higher in subjects with overt hypothyroidism than in those with overt hyperthyroidism or healthy control subjects.
Conclusions  LDL particle size, the emerging risk factor for atherosclerosis, did not appear to be significantly affected by the degree of thyroid dysfunction. Increased risk of atherosclerosis in hypothyroidism does not appear to be associated with LDL particle size, the non-traditional cardiovascular risk factor.     

Incidence of thyroid dysfunction during interferon alfa-2b and ribavirin therapy in men with chronic hepatitis C: a prospective cohort study

BACKGROUND: Thyroid dysfunction is a known complication of interferon monotherapy in women with hepatitis C virus (HCV) infection. The aims of this study were to determine the incidence and long-term outcome of thyroid dysfunction in HCV-infected men receiving interferon and ribavirin combination therapy. METHODS: We prospectively studied 225 HCV-infected men with baseline levels of thyrotropin (TSH) within the reference range who were treated with subcutaneous interferon alfa-2b (3 million units 3 times per week) and oral ribavirin (1000-1200 mg/d) for 24 to 48 weeks. Patients underwent screening of TSH levels every 12 weeks during HCV therapy and at weeks 12 and 24 after completion of treatment. Patients with abnormal TSH levels underwent a comprehensive thyroid evaluation. RESULTS: Among the 225 patients, overt thyroid disease developed in 6.7% (95% confidence interval, 3.8%-10.8%), and subclinical thyroid disease was diagnosed in 4.0% (95% confidence interval, 1.8%-7.4%). In the 12 patients with overt hypothyroidism, antithyroglobulin antibodies were present in 11 and antithyroid peroxidase antibodies were present in 10, whereas thyroid-stimulating immunoglobulins were present in 2 of the 3 individuals with overt hyperthyroidism. Most of the patients with thyroid dysfunction completed HCV therapy, and thyroid disease resolved in 10 of the 12 patients with overt hypothyroidism, 2 of the 3 with overt hyperthyroidism, and all 9 with subclinical thyroid disease. CONCLUSIONS: Men with HCV infection treated with interferon and ribavirin should undergo routine screening for thyroid disease. Treatment of HCV can be safely continued in these patients because thyroid disease responds well to treatment and is reversible in most individuals.     

Evaluation of thyroid functions with respect to iodine status and TRH test in chronic autoimmune thyroiditis

Objective: Chronic autoimmune thyroiditis (CAT) is the most common form of thyroiditis in childhood and a frequent cause of acquired hypothyroidism. The objective of this study was to evaluate the thyroid status of childrenand adolescents with CAT with respect to iodine status and diagnostic values of thyrotropin-releasing hormone (TRH) test. Methods: Seventy-one children (mean age: 11.6 years) were studied in a retrospective analysis. Free thyroxine (T4), thyrotropin (TSH), TSH response to TRH test, thyroid autoantibodies, thyroid sonography, and urinary iodine excretion (UIE) were evaluated. Results: At diagnosis, 8.5% of patients had overt hypothyroidisim and 36.6% subclinical hypothyroidism; 5.6% had overt hyperthyroidisim and 8.5% had subclinical hyperthyroidism. Of them, 40.8% were euthyroid. Median UIE was 51 mg/L in overt hypothyroidism and 84 mg/L in subclinical hypothyroidism. The values were 316 mg/L and 221 mg/L in overt and subclinical hyperthyroidism, respectively. Basal TSH showed a strong correlation with peak TSH level on TRH test. Thirty-four percent of patients with normal basal TSH level showed an exaggerated TSH response. Conclusion: Iodine deficiency was seen more in cases with hypothyroidism, while excess of iodine was observed to be more frequent in hyperthyroid patients. Iodine status was a strong predictorof the thyroid status in CAT. TRH test may be helpful in further delineating patients with subclinical hypothyroidism. Conflict of interest:None declared.     

The spectrum of thyroid disorders in systemic lupus erythematosus

To study the spectrum of thyroid disorders in systemic lupus erythematosus (SLE). Hundred SLE patients as per American Rheumatology Association(ARA) classification criteria underwent clinical examination, including assessment of disease activity (SLEDAI) and laboratory evaluation for serum triiodothyronine (T3),free thyroxine (FT4), thyroid stimulating hormone (TSH), antithyroperoxidase (TPO) antibody and antithyroglobulin (TG) antibody. Hundred age- and sex-matched apparently healthy individuals served as control. Thirty-six (36%) lupus patients had thyroid dysfunction when compared to 8 (8%) of controls and all of them were women. Primary hypothyroidism was the commonest dysfunction in 14 (14%), while subclinical hypothyroidism and subclinical hyperthyroidism was seen in 12 (12%) and 2 (2%), respectively. Eight (8%) had isolated low T3 consistent with sick euthyroid syndrome. Eighteen (50%) of thyroid dysfunction were autoimmune in nature (autoantibody positive) and rest 18 (50%) were non-autoimmune. Euthyroid state with the elevation of antibodies alone was seen in 12 (12%) of the lupus patients. In contrast, only 5 (5%) of controls had primary hypothyroidism and 3 (3%) had subclinical hypothyroidism, while none had hyperthyroidism. SLEDAI score and disease duration were compared between lupus patients with thyroid dysfunction to those with normal thyroid function. A statistically significant association was found between SLEDAI and thyroid dysfunction of sick euthyroid type.SLE disease duration had no statistically significant association with thyroid dysfunction. Prevalence of thyroid autoantibodies in lupus patients was 30% when compared to 10% of controls. Ninety-six (96%) of the SLE patients were ANA positive, while 4 (4%) of them were ANA negative but were anti-Sm antibody positive. There were no suggestions of any other autoimmune endocrine diseases like diabetes or Addison’s disease (clinically and on baseline investigations) in our lupus cohort and hence no further work up was done for these diseases. Thyroid disorders are frequent in SLE and are multifactorial with a definite higher prevalence of hypothyroidism as well as thyroid autoantibodies.     

Thyroid disorders and autoantibodies in systemic lupus erythematosus and rheumatoid arthritis patients

To determine the patterns of thyroid dysfunction and autoantibodies associated with SLE and RA patients, twenty patients with SLE and another group of twenty with RA were studied. The results were compared with those of twenty apparently healthy age- and sex- matched controls. All patients were subjected to complete history taking, thorough clinical examination and joint examination. All patients and controls were subjected to the following investigations: T3, T4, TSH, antithyroglobulin antibodies (ATGAb) and thyroid peroxidase antibodies (TPOAb). Also, complete blood picture, ESR, RF, ANA, CRP and LE cells were done. This study revealed that thyroid disorders were significantly increased in SLE patients (50%) when compared to RA (15%) (P<0.05). In SLE group, 20% had euthyroid sick syndrome, 20% had hypothyroidism (10% subclinical and 10% biochemical), and 10% had hyperthyroidism (5% subclinical and 5% biochemical). However, in RA, 10% had hypothyroidism (subclinical) and 5% had subclinical hyperthyroidism. TPOAb was found in 15% of SLE and 5% of RA patients and 10% of controls, but the titres were higher in SLE and RA patients. Also, ATGAb was found in 5% of SLE, 30% of RA patients and 10% of controls, but the titres were higher in SLE and RA patients. It is concluded that thyroid abnormalities are more implicated with euthyroid sick syndrome and hypothyroidism (subclinical and overt) than hyperthyroidism in SLE patients. SLE and RA were associated with antithyroid antibodies (TPOAb in SLE and ATGAb in RA). Performance of thyroid function tests in patients with SLE, in particular and RA as a part of the biochemical and immunological profiles, may help in early detection of associated thyroid disorders.     

Evaluation of right ventricular function in patients with thyroid dysfunction

BACKGROUND: Thyroid gland dysfunction affects the structure and function of the heart. Tissue Doppler echocardiography is a new technique, and it has been used frequently in the evaluation of ventricular function. In the present study, right ventricular function was assessed in patients with overt or subclinical hypothyroidism and hyperthyroidism and in healthy subjects using the tissue Doppler method, and results were compared. PATIENTS AND METHODS: 20 healthy subjects and 63 patients diagnosed with overt and subclinical hypothyroidism and hyperthyroidism were included in the study. Annular and myocardial systolic peak velocities, early and late diastolic peak velocities, precontraction, total contraction and relaxation times of the right ventricle were recorded by tissue Doppler echocardiography. The results of the patients were compared to those of the controls. RESULTS: Myocardial systolic velocity was significantly higher in patients with hyperthyroidism. Annular and myocardial late diastolic velocities were found to be significantly lower in patients with overt hypothyroidism. Annular precontraction time was increased in patients with overt and subclinical hypothyroidism. Myocardial precontraction time was decreased in patients with hyperthyroidism, and increased in patients with overt hypothyroidism patients. Annular relaxation time was increased in patients with overt hypothyroidism. CONCLUSIONS: Right ventricular function is affected in patients with thyroid diseases. The tissue Doppler technique is a suitable tool to detect impairments in right ventricular function. There is a significant correlation between serum thyroid hormone levels and right ventricular velocities and time intervals.     

Long term thyroid function after subtotal thyroidectomy for Graves' disease

Between 1973 and 1980, 93 patients with Graves' disease underwent subtotal thyroidectomy by the same surgeon (the size of thyroid remnant was 4 g per side). No case of operative mortality, no case of thyroid storm nor of surgical complications occurred. Three months after surgery 40% of patients were euthyroid, 25% had overt hypothyroidism, 35% had subclinical hypothyroidism. In the following yr important variations of thyroid function were observed. The number of patients with subclinical hypothyroidism decreased slowly (22% and 9% at 3 and 6 yr, respectively), and some became euthyroid, some hypothyroid, others relapsed. Seven patients had recurrent hyperthyroidism. In particular at 3 yr 45% of patients were euthyroid, 28% had overt hypothyroidism, 22% had subclinical hypothyroidism, 4% had recurrence; at 6 yr 56% were euthyroid, 32% had overt hypothyroidism, 9% had subclinical hypothyroidism, 3% had recurrence. Four out of the 8 patients operated under 20-yr-old became hypothyroid in comparison with only 2 out of the 15 patients over 50-yr-old. Relapses were present only in patients operated at less than 40-yr and only in females. No correlation was found between thyroid lymphocytic infiltration and thyroid function after surgery, nor between the presence of antithyroid antibodies and hypothyroidism. All cases who relapsed had high TMA titers both before and after operation. This study confirms the need for accurate follow-up after subtotal thyroidectomy for Graves' disease.     

Frequency of Thyroid Dysfunction in Diabetic Patients: Value of Annual Screening

A randomly selected group of 1310 adult diabetic patients attending a diabetic outpatient clinic received annual screening for thyroid disease, by estimating serum free thyroxine and TSH concentrations. The overall prevalence of thyroid disease was found to be 13.4%, and was highest (31.4%) in Type 1 diabetic females, and lowest in Type 2 diabetic males (6.9%). As a direct result of screening, new thyroid disease was diagnosed in 6.8% (89 patients) of the population screened; the commonest diagnosis was subclinical hypothyroidism (4.8%), followed by hypothyroidism (0.9%), hyperthyroidism 0.5%), and subclinical hyperthyroidism (0.5%). Female patients with Type 1 diabetes had the highest annual risk of developing thyroid disease (12.3%), but all patient groups had a higher incidence of thyroid dysfunction, compared to that reported in the general population. This study suggests that thyroid function should be screened annually in diabetic patients to detect asymptomatic thyroid dysfunction which is increased in frequency in a diabetic population.     

Prevalence of thyroid dysfunction in Thai HIV-infected patients

Increasing prevalence of thyroid function abnormality has been reported in HIV-infected patients. We aim to evaluate the prevalence and assess risk factors of thyroid dysfunction in Thai HIV-infected patients. A cross-sectional study was conducted. Serum thyroid hormone concentrations (FT4, FT3, and TSH) and thyroid autoantibodies (TgAb and TPOAb) were measured by electrochemiluminescence immunoassay. A total of 200 HIV-infected outpatients were included. Ninety-seven patients (48.5%) were men (mean age of 36.3 +/- 8.3 years). Duration of HIV infection was 49.6 +/- 35.1 months and 53% had previous opportunistic infections (OI). Mean CD4 cell count was 340.6 +/- 173.1 cells/mm(3). Of these, 167 patients (83.5%) received antiretroviral therapy (ARV). Abnormal thyroid function test was detected in 32 patients (16%). Twenty-seven patients (13.5%) had decreased thyroid function (primary hypothyroidism 3, subclinical hypothyroidism 12, and low FT4 with low or normal TSH 12) whereas 5 patients had increased thyroid function (overt hyperthyroidism 1, subclinical hyperthyroidism 1, and isolated high FT3 3). None had clinical features of thyroid hormone dysfunction. Thirteen patients (6.5%) had thyroid antibody positive. Patients who received ARV had higher mean FT3 levels than those who were na?ve to ARV (p = 0.017). History of previous OI was found to be an independently significant risk factor for decreased thyroid function with the odds ratio of 3.28 (95% CI =1.183-9.099; p = 0.022). Hypothyroidism was common among Thai HIV-infected patients, especially in those who had history of previous OI. It is therefore suggested that screening and/or monitoring of thyroid hormone in HIV-infected patients should be considered.     

A sensitive thyroid stimulating hormone assay for screening of thyroid functional disorder in elderly Japanese

The use of a screening test for thyroid functional disorder by sensitive thyroid stimulating hormone assay in the elderly was investigated. The basal thyroid stimulating hormone levels predicted the response of thyroid stimulating hormone to thyrotropin releasing hormone; it was suppressed in 99 (99.0%) of 100 hyperthyroid patients. Therefore, not only primary hypothyroidism but also hyperthyroidism can be excluded when the serum thyroid stimulating hormone levels are normal. An epidemiological study was then performed on 2,421 (76.7%) of the Japanese general population aged 40 or over recruited from the residents in Hisayama town and also in 122 residents between 20 and 40 years of age. Additional free T4 measurement was necessary in about 10% of the residents with abnormal TSH levels to confirm the diagnosis of hyperthyroidism or distinguish latent from overt hypothyroidism. There was a significant correlation between age and serum thyroid stimulating hormone levels after logarithmic conversion (r = 0.1533, P less than .001). The prevalence of thyroid dysfunction found in 1,026 males and in 1,395 females aged 40 or over was, respectively: hyperthyroidism, less than 0.1% and 0.2%, latent (subclinical) hypothyroidism, 3.2% and 5.5%, and overt hypothyroidism, 0.4% and 0.7%. We conclude that the screening with this sensitive thyroid stimulating hormone assay and additional free T4 measurement is useful for detection of patients with thyroid functional disorder.     

Tobacco smoking and thyroid function: a population-based study

BACKGROUND: The association between tobacco smoking and thyroid function is incompletely understood. METHODS: In a cross-sectional, population-based study conducted between August 15, 1995, and June 18, 1997, of 20 479 women and 10 355 men without previously known thyroid disease, we calculated the geometric mean serum concentration of thyrotropin and the prevalence of hypothyroidism and hyperthyroidism among current, former, and never smokers. RESULTS: Among women, the mean thyrotropin level was lower in current (1.33 mIU/L; 95% confidence interval [CI], 1.29-1.36 mIU/L) and former smokers (1.61 mIU/L; 95% CI, 1.56-1.65 mIU/L) compared with never smokers (1.66 mIU/L; 95% CI, 1.63-1.70 mIU/L). Similarly, among men, the mean thyrotropin level was lower in current (1.40 mIU/L; 95% CI, 1.36-1.44 mIU/L) and former smokers (1.61 mIU/L; 95% CI, 1.57-1.66 mIU/L) compared with never smokers (1.70 mIU/L; 95% CI, 1.66-1.75 mIU/L). In former smokers, thyrotropin levels increased gradually with time since smoking cessation (P for trend < .001). Among current smokers, moderate daily smoking was associated with higher thyrotropin levels than heavier smoking. In women, the prevalence of overt hypothyroidism was lower in current smokers compared with never smokers (odds ratio, 0.60; 95% CI, 0.38-0.95), whereas the prevalence of overt hyperthyroidism was higher among current smokers (odds ratio, 2.37; 95% CI, 1.34-4.20). The associations related to subclinical thyroid dysfunction were similar to those for overt thyroid disease. CONCLUSIONS: These findings indicate that smoking is negatively associated with hypothyroidism but positively associated with hyperthyroidism. The associations with smoking cessation suggest that smoking may have reversible effects on thyroid function. Notably, we report for the first time, to our knowledge, a lower prevalence of overt hypothyroidism among current smokers.     

Thyroid Function Abnormalities and Cognitive Impairment in Elderly People: Results of the Invecchiare in Chianti Study

OBJECTIVES: To investigate thyroid function testing abnormalities in older persons and to explore the relationship between thyroid dysfunction and cognition.
DESIGN: Cross-sectional.
SETTING: Community-based.
PARTICIPANTS: One thousand one hundred seventy-one men and women aged 23 to 102.
MEASUREMENTS: Thyroid function was evaluated by measuring plasma concentrations of thyrotropin (TSH), free thyroxine (FT4), and free triiodothyronine (FT3). Cognition was evaluated using the Mini-Mental State Examination (MMSE). Prevalence of overt and subclinical thyroid dysfunction was evaluated in different age groups (<65 vs ≥65). Age trends in TSH, FT4, and FT3 were examined in euthyroid participants. The cross-sectional association between thyroid dysfunction and MMSE score was evaluated adjusting for confounders.
RESULTS: Subclinical hypothyroidism and subclinical hyperthyroidism were more prevalent in older than in younger participants (subclinical hypothyroidism, 3.5% vs 0.4%, P <.03; subclinical hyperthyroidism, 7.8% vs 1.9%, P <.002). In euthyroid participants, TSH and FT3 declined with age, whereas FT4 increased. Older participants with subclinical hyperthyroidism had lower MMSE scores than euthyroid subjects (22.61±6.88 vs 24.72±4.52, P <.03). In adjusted analyses, participants with subclinical hyperthyroidism were significantly more likely to have cognitive dysfunction (hazard rate=2.26, P =.003).
CONCLUSION: Subtle age-related changes in FT3, FT4, and TSH occur in individuals who remain euthyroid. Subclinical hyperthyroidism is the most prevalent thyroid dysfunction in Italian older persons and is associated with cognitive impairment.     

Screening for thyroid dysfunction in a community population of diabetic patients

In a general practice population of 11 300 patients, 223 were known to have diabetes mellitus. Thirteen diabetic patients (5.8 %) had a previous diagnosis of thyroid disease. The study excluded 17 patients who received sole diabetes care at a secondary referral centre (of whom 5 had a previous diagnosis of thyroid disease), 8 with a previous diagnosis of thyroid disease receiving community care, and 1 patient who declined screening. New thyroid disease was diagnosed in 11 patients (8 female, 3 male): 5 with primary hypothyroidism, 4 with subclinical hypothyroidism, 1 with hyperthyroidism and 1 with subclinical hyperthyroidism. Thus the prevalence of undiagnosed thyroid disease in diabetic patients receiving community diabetes care was 5.5 % (9.5 % of female patients), and the prevalence of thyroid disease (previusly known and diagnosed as a result of screening) in the entire population of diabetic patients registered in the general practice was 10.8 %. These findings suggest that screening for thyroid disease should be considered in patients receiving diabetes care in the community. © 1998 John Wiley & Sons, Ltd.     

Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study

OBJECTIVES: Many afflictions have been associated with celiac disease, but chance associations may exists. The aim of this study was to establish, by means of a multicenter prospective study, the prevalence of thyroid impairment among adult patients with newly diagnosed celiac disease and to evaluate the effect of a 1-yr gluten withdrawal on thyroid function. METHODS: A total of 241 consecutive untreated patients and 212 controls were enrolled. In 128 subjects a thorough assessment, including intestinal biopsy, was repeated within 1 yr of dietary treatment. Thyroid function was assayed by measuring the levels of TSH, free T3, free T4, thyroperoxidase, and thyroid microsome antibodies. RESULTS: Thyroid disease was 3-fold higher in patients than in controls (p < 0.0005). Hypothyroidism, diagnosed in 31 patients (12.9%) and nine controls (4.2%), was subclinical in 29 patients and of nonautoimmune origin in 21. There was no difference regarding hyperthyroidism, whereas autoimmune thyroid disease with euthyroidism was present in 39 patients (16.2%) and eight controls (3.8%). In most patients who strictly followed a 1-yr gluten withdrawal (as confirmed by intestinal mucosa recovery), there was a normalization of subclinical hypothyroidism. Twenty-five percent of patients with euthyroid autoimmune disease shifted toward either a subclinical hyperthyroidism or subclinical hypothyroidism; in these subjects, dietary compliance was poor. In addition, 5.5% of patients whose thyroid function was normal while untreated developed some degree of thyroid dysfunction 1 yr later. CONCLUSIONS: The greater frequency of thyroid disease among celiac disease patients justifies a thyroid functional assessment. In distinct cases, gluten withdrawal may single-handedly reverse the abnormality.     

糖尿病住院患者434例甲状腺疾病患病率分析

目的 探讨江苏地区糖尿病患者中甲状腺疾病的现患情况.方法 横向断面调查2006年10月至2007年6月于南京医科大学第一附属医院就诊的长期居住于江苏地区的434例糖尿病患者的甲状腺功能,其中109例患者作了甲状腺超声检查.结果 (1)糖尿病患者合并甲状腺疾病的患病率为23.27%,女性多见(P＜0.05),其中甲状腺功能减退者占16.36%(临床甲减4.15%,亚临床甲减12.21%),明显高于甲状腺功能亢进者6.91%(临床甲亢4.61%,亚临床甲亢2.30%),两者差异有统计学意义.(2)糖尿病患者中,甲状腺功能减退的患病率随患者年龄和糖尿病病程的增加而增加(P＜0.01);甲状腺功能亢进的患病率随糖尿病痛程的增加而降低(P＜0.05),随年龄的增加患病率改变无统计学意义.(3)糖尿病患者中甲状腺结节患病率为40.37%,性别差异无统计学意义,患病率随年龄的增加而增加(P＜0.05),不随糖尿病痛程的增加而增加.结论 糖尿病患者合并甲状腺疾病较常见,可能影响糖尿病患者的病情和预后,筛查和随访糖尿病患者的甲状腺功能及形态学状态具有重要的临床意义.     

Subclinical thyroid dysfunction and blood pressure: a community-based study

OBJECTIVE: Overt hypothyroidism and hyperthyroidism are associated with hypertension, but it is uncertain whether the same is true of subclinical hypothyroidism and hyperthyroidism. DESIGN, SUBJECTS AND MEASUREMENTS: Cross-sectional study of 2033 participants (aged 17-89 years) in the Busselton Thyroid Study who did not have a history of thyroid disease. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and the prevalence of hypertension (defined as SBP >or=140 mmHg, DBP >or=90 mmHg or on treatment for hypertension) in subjects with thyroid dysfunction and euthyroid subjects were compared using linear regression models. Subjects with treated hypertension (N = 299) were excluded from analyses of SBP and DBP but included in analyses of hypertension prevalence. RESULTS: Mean SBP, DBP and the prevalence of hypertension did not differ significantly between subjects with subclinical hypothyroidism (N = 105) and euthyroid subjects (N = 1859), nor did they differ between subjects with serum TSH concentrations in the upper reference range (2.0-4.0 mU/l; N = 418) and those with TSH concentrations in the lower reference range (0.4-2.0 mU/l; N = 1441). The prevalence of hypertension was higher in subjects with subclinical hyperthyroidism than euthyroid subjects (prevalence odds ratio 2.8, 95% confidence interval 1.3-6.0 adjusted for age, age(2) and sex), but this was based on a small number of subjects with subclinical hyperthyroidism (N = 35). CONCLUSIONS: Subclinical hypothyroidism is not associated with hypertension. The observed association between subclinical hyperthyroidism and hypertension requires confirmation in a larger sample.     

The prevalence of hyperprolactinaemia in overt and subclinical hypothyroidism

The aims of this study were to: 1) determine the prevalence of hyperprolactinaemia in patients with newly diagnosed subclinical and overt hypothyroidism, and 2) investigate the change in PRL levels with treatment. In this observational study, patients with a new diagnosis of hypothyroidism in our endocrinology clinic were approached for participation, as were healthy controls. Patients with medical reasons for having elevated PRL levels, lactating and pregnant women were excluded from the study. No patient had kidney or liver disease. After examination to determine if clinical causes of PRL elevation were present, serum levels of thyrotropin (TSH), free thyroxine, free triiodothyronine and PRL were measured and correlation of PRL levels with the severity of hypothyroidism (overt or subclinical) was performed. Fifty-three patients (45 women, 8 men, mean age 45.3 ± 12.2 years) had overt hypothyroidism. One hundred forty-seven patients (131 women, 16 men, mean age 42.9 ± 12.6 years) had subclinical hypothyroidism. One hundred healthy persons (85 women, 15 men, mean age 43.9 ± 11.4 years) participated as controls. The same blood tests were repeated in patients after normalization of TSH levels with L-thyroxine treatment. PRL elevation was found in 36% of patients with overt hypothyroidism, and in 22% of patients with subclinical hypothyroidism. PRL levels decreased to normal in all patients after thyroid functions normalized with L-thyroxine treatment. In the hypothyroid patients (overt and subclinical) a positive correlation was found between TSH and PRL levels (r=0.208, p=0.003). PRL regulation is altered in overt and subclinical hypothyroidism, and PRL levels normalize with appropriate L-thyroxine treatment.