治疗 50 岁以上亚临床甲亢患者:随机对照研究。

IF 3.5 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM European Thyroid Journal Pub Date : 2024-08-01 DOI:10.1530/ETJ-24-0121
Bernard Goichot, François Lefebvre, Stéphane Vinzio, Anne Cailleux, Jean-Marc Kuhn, Olivier Schneegans, Bodgan Catargi, Olivier Gilly, Philippe Baltzinger, Nicolas Meyer, Philippe Caron
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引用次数: 0

摘要

目的:亚临床甲状腺功能亢进症(SCH)很常见,与老年人心房颤动(AF)风险有关。目前的指南依赖于低水平的证据:方法:随机临床试验,包括 50 岁及以上的 TSH 患者:144名患者(平均年龄为65.3±8.9岁,76%为女性)被随机分组,其中74人接受监测,70人接受治疗。监测组和治疗组分别有 4 名和 1 名患者出现房颤(P=0.238)。然而,治疗组中出现房颤的患者的 TSH 维持在 65y 或 TSHC 结论:由于招募困难,本研究未能证明SCH治疗能显著降低50岁以上甲状腺自主患者的房颤发生率,即使所有发生房颤的患者都能维持TSH。
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Treatment of subclinical hyperthyroidism in patients older than 50 years: A randomized controlled study.

Objective: Subclinical hyperthyroidism (SCH) is common and associated with atrial fibrillation (AF) risk in the elderly. Current guidelines rely on a low level of evidence.

Methods: Randomized clinical trial including patients 50 years and older, with TSH <0.4 mU/L and normal thyroid hormone concentrations. All patients showed autonomy on thyroid scan. They were randomized either to receive radioiodine (I131) or to be monitored and treated only if they underwent AF or evolved towards overt hyperthyroidism. Primary outcome was the onset of new AF. Secondary outcomes were treatment-induced hypothyroidism rate and health-related quality of life.

Results: 144 patients (mean age 65.3±8.9y, 76% female) were randomized, 74 to surveillance and 70 to treatment. Four patients in the surveillance group and one in the treatment group developed AF (p=0.238). However, the patient who developed AF in the treatment group maintained TSH <0.4 mU/L at AF onset. A post-hoc analysis was carried out and showed that when normalization of TSH was considered, the risk of AF was significantly reduced (p=0.0003). In the surveillance group, several patients showed no classical characteristics associated with AF risk, including age>65y or TSH<0.1mU/L. Of 94 patients treated using radioiodine, 25% developed hypothyroidism during follow-up.

Conclusions: Due to recruitment difficulties this study failed to demonstrate that SCH treatment can reduce significantly the incidence of AF in patients older than 50 years with thyroid autonomy even if all the patients who developed AF maintained TSH <0.4 mU/L. This result must be balanced with the increased risk of radioiodine-induced hypothyroidism.

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来源期刊
European Thyroid Journal
European Thyroid Journal Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
6.70
自引率
2.10%
发文量
156
期刊介绍: The ''European Thyroid Journal'' publishes papers reporting original research in basic, translational and clinical thyroidology. Original contributions cover all aspects of the field, from molecular and cellular biology to immunology and biochemistry, from physiology to pathology, and from pediatric to adult thyroid diseases with a special focus on thyroid cancer. Readers also benefit from reviews by noted experts, which highlight especially active areas of current research. The journal will further publish formal guidelines in the field, produced and endorsed by the European Thyroid Association.
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