The change in thyroid function categories with time in patients with subclinical hypothyroidism: a systematic review and meta-analysis.

IF 2.8 3区 医学 Q3 ENDOCRINOLOGY & METABOLISM BMC Endocrine Disorders Pub Date : 2024-10-25 DOI:10.1186/s12902-024-01754-7
Xueqi Zhang, Guofeng Zhang, Songwen Wang, Jing Jin, Shimiao Zhang, Xiaochun Teng
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Abstract

Background: Subclinical hypothyroidism (SCH) is characterized by elevated levels of thyroid hormone (TSH) and normal levels of free thyroxine (FT4). The outcomes of SCH patients are crucial for determining treatment plans; therefore, our aim is to summarize the existing prospective studies to understand the changes in thyroid function over time in SCH patients and the factors influencing these changes, providing references for clinical diagnosis and treatment.

Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science for prospective follow-up studies on natural outcomes of SCH published until September 2024. Results are presented as the overall risk ratio (RR) and 95% confidence intervals (CI).

Results: We reviewed 8 prospective follow-up studies involving 1,859 individuals and extracted data from them for a meta-analysis. We found that when TSH levels are ≥ 10 mU/L, patients with SCH are more likely to progress to overt hypothyroidism (OH) (RR11.38, 95%CI 4.98-26.03, P<0.001) and were less likely to return to normal TSH levels (RR 0.20, 95%CI 0.09-0.42, P<0.001) compared to patients with TSH between 4.5 and 9.9 mU/L. In addition, patients who test positive for thyroid peroxidase antibodies (TPOAb) are more likely to progress to OH (RR 2.53, 95% CI 1.86-3.44, P < 0.001) and less likely to return to euthyroidism (RR 0.68, 95% CI 0.60-0.76, P < 0.001) compared to TPOAb-negative patients.

Conclusion: The results indicated that a large proportion of patients diagnosed with SCH will return to normal TSH levels or maintain SCH. Additionally, patients with TSH levels ≥ 10 mU/L or positive for TPOAb are more likely to experience progression and should be closely monitored. However, we did not find any gender differences in the natural outcome of SCH.

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亚临床甲减患者甲状腺功能分类随时间的变化:系统综述和荟萃分析。
背景:亚临床甲状腺功能减退症(SCH)的特点是甲状腺激素(TSH)水平升高而游离甲状腺素(FT4)水平正常。SCH患者的治疗结果对于确定治疗方案至关重要;因此,我们的目的是总结现有的前瞻性研究,以了解SCH患者甲状腺功能随时间的变化以及影响这些变化的因素,为临床诊断和治疗提供参考:我们检索了PubMed、Embase、Cochrane Library和Web of Science上截至2024年9月发表的有关SCH自然结果的前瞻性随访研究。结果显示为总风险比(RR)和 95% 置信区间(CI):我们回顾了涉及 1859 人的 8 项前瞻性随访研究,并从中提取数据进行了荟萃分析。我们发现,当TSH水平≥10 mU/L时,SCH患者更有可能发展为明显甲状腺功能减退症(OH)(RR11.38,95%CI 4.98-26.03,PC结论:结果表明,大部分确诊为SCH的患者TSH水平将恢复正常或保持SCH。此外,TSH 水平≥ 10 mU/L 或 TPOAb 阳性的患者更有可能病情恶化,应密切监测。不过,我们并未发现SCH的自然结果存在性别差异。
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来源期刊
BMC Endocrine Disorders
BMC Endocrine Disorders ENDOCRINOLOGY & METABOLISM-
CiteScore
4.40
自引率
0.00%
发文量
280
审稿时长
>12 weeks
期刊介绍: BMC Endocrine Disorders is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of endocrine disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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