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Balwinder Singh Anastasia K. Yocum Rebecca Strawbridge Katherine E. Burdick Caitlin E. Millett Amy T. Peters Sarah H. Sperry Giovanna Fico Eduard Vieta Norma Verdolini Ophelia Godin Marion Leboyer Bruno Etain Ivy F. Tso Brandon J. Coombes Melvin G. McInnis Andrew A. Nierenberg Allan H. Young Melanie M. Ashton Michael Berk Lana J. Williams Kamyar Keramatian Lakshmi N. Yatham Bronwyn J. Overs Janice M. Fullerton Gloria Roberts Philip B. Mitchell Ole A. Andreassen Ana C. Andreazza Peter P. Zandi Daniel Pham Joanna M. Biernacka Mark A. Frye The FACE-BD Collaborators The Global Bipolar Cohort Collaborative 《Bipolar disorders》2024,26(1):22-32
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Connie M. Rhee Kamyar Kalantar-Zadeh Vanessa Ravel Elani Streja Amy S. You Steven M. Brunelli Danh V. Nguyen Gregory A. Brent Csaba P. Kovesdy 《Mayo Clinic proceedings. Mayo Clinic》2018,93(5):573-585
Objective
Given that patients with non–dialysis-dependent chronic kidney disease (NDD-CKD) have a disproportionately higher prevalence of hypothyroidism compared with their non-CKD counterparts, we sought to determine the association between thyroid status, defined by serum thyrotropin (TSH) levels, and mortality among a national cohort of patients with NDD-CKD.Patients and Methods
Among 227,422 US veterans with stage 3 NDD-CKD with 1 or more TSH measurements during the period October 1, 2004, to September 30, 2012, we first examined the association of thyroid status, defined by TSH categories of less than 0.5, 0.5 to 5.0 (euthyroidism), and more than 5.0 mIU/L, with all-cause mortality. We then evaluated 6 granular TSH categories: less than 0.1, 0.1 to less than 0.5, 0.5 to less than 3.0, 3.0 to 5.0, more than 5.0 to 10.0, and more than 10.0 mIU/L. We concurrently examined thyroid status, thyroid-modulating therapy, and mortality in sensitivity analyses.Results
In expanded case-mix adjusted Cox analyses, compared with euthyroidism, baseline and time-dependent TSH levels of more than 5.0 mIU/L were associated with higher mortality (adjusted hazard ratios [aHRs] [95% CI], 1.19 [1.15-1.24] and 1.23 [1.19-1.28], respectively), as were baseline and time-dependent TSH levels of less than 0.5 mIU/L (aHRs [95% CI], 1.18 [1.15-1.22] and 1.41 [1.37-1.45], respectively). Granular examination of thyroid status showed that incrementally higher TSH levels of 3.0 mIU/L or more were associated with increasingly higher mortality in baseline and time-dependent analyses, and TSH categories of less than 0.5 mIU/L were associated with higher mortality (reference, 0.5-<3.0 mIU/L) in baseline analyses. In time-dependent analyses, untreated and undertreated hypothyroidism and untreated hyperthyroidism were associated with higher mortality (reference, spontaneous euthyroidism), whereas hypothyroidism treated-to-target showed lower mortality.Conclusion
Among US veterans with NDD-CKD, high-normal TSH (≥3.0 mIU/L) and lower TSH (<0.5 mIU/L) levels were associated with higher death risk. Interventional studies identifying the target TSH range associated with the greatest survival in patients with NDD-CKD are warranted. 相似文献66.
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