Natural history of mild subclinical hypothyroidism in a middle-aged and elderly Chinese population: a prospective study

Endocrine journal

Meng Zhao¹  Lu Liu¹  Qingbo Guan¹  Haiqing Zhang¹  Xiang Li¹  Donghu Zhen²  Xulei Tang²  Shujian Ge³  Ling Gao⁴ 

[1] Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong 250021, China;Department of Endocrinology and Metabolism, The First Hospital of Lanzhou University, Lanzhou 730000, China;Department of Science and Education, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong 250021, China;Scientific Center, Shandong Provincial Hospital affiliated to Shandong University, Shandong 250021, China

关键词: Natural history;    Hypothyroidism;    Thyrotropin;    Prospective study;    Risk factors;   

DOI  :  10.1507/endocrj.EJ16-0549

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

Subclinical hypothyroidism (SCH) has a high global prevalence.Most SCH patients have mild cases (thyrotropin ≤10 mIU/L).Treatment recommendations for mild SCH are controversial, which raises concerns about the natural history of mild SCH.We aimed to clarify the natural history of mild SCH.This is a prospective population-based study.We measured thyroid function in 11,000 participants in the REACTION study and followed 505 newly diagnosed mild SCH patients aged 40-years or older between 2011 and 2014.Logistic regression analysis was used to seek baseline parameters associated with the natural outcomes of mild SCH.Among 505 mild SCH patients, 221 (43.8%) had persistent SCH, 251 (49.7%) reverted to euthyroidism, and 17 (3.4%) progressed to overt hypothyroidism (OH).Patients with higher baseline total cholesterol (TC, between 201.0-240.0 mg/dL or >240.0 mg/dL vs. <201.0 mg/dL, p = 0.048 and 0.006, respectively) or positive thyroid peroxidase antibodies (TPOAb, p = 0.009) had higher risks of progression to OH, while those with higher baseline creatinine (CR, between 0.71-0.80 mg/dL or >0.80 mg/dL vs. ≤0.65 mg/dL, p = 0.031 and 0.004, respectively), higher baseline thyrotropin (≥7 mIU/L, p < 0.001) or older (>60 years vs. ≤50 years, p = 0.012) had lower odds of reverting to euthyroidism.In conclusion, TPOAb and TC seem to be more important predictors of progression to OH than initial thyrotropin, whereas high baseline thyrotropin or CR were negative correlated with reversion to euthyroidism.The prognostic value of TC and CR in mild SCH should be considered.

【 授权许可】

Unknown