Comparison of pathophysiology in subclinical hyperthyroidism with different etiologies

IF 1.3 4区 医学 Q4 ENDOCRINOLOGY & METABOLISM
Hanna Deguchi-Horiuchi, Mitsuru Ito, Sawako Takahashi, Kazuyoshi Kousaka, Mako Hisakado, Shuji Fukata, Takumi Kudo, Eijun Nishihara, Mitsushige Nishikawa, Akira Miyauchi, Takashi Akamizu
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Abstract

Subclinical hyperthyroidism (SHyper) is defined as normal levels of free thyroxine (fT4) and free triiodothyronine (fT3) with suppressed levels of TSH. Previous studies have reported the individual pathophysiology of endogenous SHyper patients and athyreotic patients receiving TSH suppression therapy with levothyroxine; however, apparently no studies have compared the two conditions. Five-hundred-forty untreated endogenous SHyper patients and 1,024 patients receiving TSH suppression therapy who underwent total thyroidectomy for papillary thyroid carcinoma were sampled. Thyroid hormone profiles and peripheral indices related to thyrotoxicosis were investigated in endogenous SHyper patients, athyreotic patients receiving TSH suppression therapy, and healthy participants. Endogenous SHyper patients showed significantly higher thyroid hormone levels (fT4 [p < 0.001] and fT3 [p < 0.001]), and peripheral indices showed a significant tendency towards thyrotoxicosis (strong TSH suppression: alkaline phosphatase [ALP, p < 0.001], creatinine [Cre, p < 0.001], pulse rate [p < 0.05]; and mild TSH suppression: Cre [p < 0.05]) than healthy participants. In contrast, athyreotic patients receiving TSH suppression therapy showed a significant tendency towards thyrotoxicosis than healthy participants only when TSH was strongly suppressed (fT3 [p < 0.001] and Cre [p < 0.001]). Endogenous SHyper patients showed significantly higher fT3 levels (p < 0.001) than athyreotic patients receiving TSH suppression therapy; however, there was a significant tendency towards thyrotoxicosis only when TSH was strongly suppressed (ALP [p < 0.05] and pulse rate [p < 0.05]). The effects of endogenous SHyper and TSH suppression therapy on target organ function are different. Although the serum thyroid hormone profile is similar to that of the thyrotoxic state, athyreotic patients receiving TSH suppression therapy with mildly suppressed serum TSH levels are not thyrotoxic.

不同病因引起的亚临床甲亢的病理生理学比较
亚临床甲状腺功能亢进症(Shyper)是指游离甲状腺素(fT4)和游离三碘甲状腺原氨酸(fT3)水平正常,而促甲状腺激素(TSH)水平受到抑制。以前的研究曾报道过内源性 SHyper 患者和接受左甲状腺素抑制促甲状腺激素治疗的无甲状腺功能患者各自的病理生理学情况,但显然没有研究对这两种情况进行过比较。研究人员对接受甲状腺乳头状癌全甲状腺切除术的 540 名未经治疗的内源性 SHyper 患者和 1024 名接受 TSH 抑制治疗的患者进行了采样。研究了内源性SHyper患者、接受促甲状腺激素抑制疗法的甲亢患者和健康参与者的甲状腺激素谱和与甲亢相关的外周指标。内源性 SHyper 患者的甲状腺激素水平明显更高(fT4 [p < 0.001] 和 fT3 [p < 0.001]),外周指标也显示出明显的甲亢倾向(强 TSH 抑制:碱性磷酸酶 [ALP,p < 0.001]、肌酐 [Cre,p < 0.001]、脉搏率 [p < 0.05];轻度 TSH 抑制:Cre [p < 0.001]、脉搏率 [p < 0.05]):Cre[p<0.05])。相比之下,接受 TSH 抑制治疗的甲亢患者只有在 TSH 被强力抑制时(fT3 [p < 0.001] 和 Cre [p < 0.001])才会比健康参试者表现出明显的甲亢倾向。内源性 SHyper 患者的 fT3 水平(p < 0.001)明显高于接受 TSH 抑制治疗的甲亢患者;然而,只有当 TSH 被强烈抑制时,才会出现明显的甲亢倾向(ALP [p < 0.05] 和脉搏率 [p < 0.05])。内源性 SHyper 和 TSH 抑制疗法对靶器官功能的影响是不同的。虽然血清甲状腺激素谱与甲亢状态相似,但接受 TSH 抑制疗法的甲亢患者血清 TSH 水平受到轻度抑制,并不属于甲亢。
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来源期刊
Endocrine journal
Endocrine journal 医学-内分泌学与代谢
CiteScore
4.30
自引率
5.00%
发文量
224
审稿时长
1.5 months
期刊介绍: Endocrine Journal is an open access, peer-reviewed online journal with a long history. This journal publishes peer-reviewed research articles in multifaceted fields of basic, translational and clinical endocrinology. Endocrine Journal provides a chance to exchange your ideas, concepts and scientific observations in any area of recent endocrinology. Manuscripts may be submitted as Original Articles, Notes, Rapid Communications or Review Articles. We have a rapid reviewing and editorial decision system and pay a special attention to our quick, truly scientific and frequently-citable publication. Please go through the link for author guideline.
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