88例亚临床甲状腺功能异常患者的2年随访分析

目的 总结亚临床甲状腺功能减退症(亚临床甲减)和亚临床甲状腺功能亢进症(亚临床甲亢)患者的自然转归.方法 对2002年9-12月在我院门诊体检的人员进行问卷调查,并测定血清促甲状腺素(TSH)、甲状腺激素(TT3和TT4.)、过氧化物酶抗体(TPOAb),筛选出亚临床甲减58例,亚临床甲亢30例.随访2年,2年后重复上述检查.结果 58例亚临床甲减者中13例(22.4%)甲状腺功能转为正常.44例(75.9%)仍为亚临床甲减.1例(1.7%)进展为临床甲减.甲状腺明显肿大及血清TSH浓度是影响亚临床甲减转归的危险因素(P均＜0.05);30例亚临床甲亢中22例(73.3%)转为正常,2例(6.7%)仍为亚临床甲亢,1例(3.3%)发展为临床甲亢,5例(16.7%)转为亚临床甲减.血清TSH浓度可能影响亚临床甲亢的转归(P＜0.05).结论 在2年内仅有少数亚临床甲状腺功能异常患者进展为临床状态.甲状腺明显肿大、初始血清TSH浓度＞10 mU/L是促使亚临床甲减进展为临床甲减的高危因素;而初始血清TSH浓度≤0.15 mU/L的亚临床甲亢向异常转归的可能性较大.

Two years follow-up study of eighty-eight patients with subclinical thyroid dysfunction

Objective To follow-up the patients with subclinical hypothyroidism and subclinical hyperthyroidism for 2 years and to analyse its natural course. Methods Questionaire was performed and sera was sampled in the population who took a physical examination in the clinic of endocrinology department of First Hospital of Peking University from September to December in 2002. Serum thyrotropin(TSH), thyroid hormone(TT4 and TT3), thyroid peroxidase antibody(TPOAb)were measured. Fifty-eight patients with subclinical hypothyroidism and 30 with subclinical hyperthyroidism were followed-up for study 2 years and the above parameters were reexamined. We eveluated the risk factors that affected the 2-year natural course of subclinical thyroid dysfunction. Results In the 58 patients with subclinical hypothyroidism 13(22.4%) returned to normal;44(75.9%)remained subclinically abnormal and 1(1.7%)progressed to clinical hypothyroidism.The palpable thyroid size and the concentration of serum TSH were the high-risk factors of progression to clinical hypothyroidism(P<0.05 respectively). In 30 patients with subclinical hyperthyroidism, 22 patients(73.3%) returned to normal, 2(6.7%)remained subclinical abnormal, 1(3.3%)developed clinical hyperthyroidism and 5(16.7%) turned to subclinical hypothyroidism. The initial concentration of serum TSH affected the natural course of subclinical hyperthyroidism (P<0.05). Conclusions Only a minor group of patients with subclinical thyroid dysfunction develop to clinical thyroid abnormalty in 2 years . Palpable thyroid size and high concentration of serum TSH(>10 mIU/L)may predict the affect progression to clinical hypothyroidism, and the patients with serum TSH lower than 0.15 mIU/L may be a risk factor for progression to thyroid dysfunction.