Strieder Thea G A, Prummel Mark F, Tijssen Jan G P, Endert Eric, Wiersinga Wilmar M
Departments of Endocrinology and Metabolism and Cardiology, Academical Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
Clin Endocrinol (Oxf). 2003 Sep;59(3):396-401. doi: 10.1046/j.1365-2265.2003.01862.x.
Autoimmune thyroid disease (AITD) is a common disorder especially in women, and both genetic and environmental factors are involved in its pathogenesis. We wanted to gain more insight into the contribution of various environmental factors. Therefore, we started a large prospective cohort study in subjects at risk of developing AITD, for example healthy female relatives of AITD patients. Here we report on their baseline characteristics.
Only first- or second-degree female relatives of patients with documented AITD were included.
Smoking habits, oestrogen use, pregnancy history and iodine exposure were assessed by questionnaires, and correlated to the thyroid function and antibody status.
Of 803 subjects, 440 came from families with more than one patient with documented AITD. Of these families, 33% had documented cases of both Graves' disease and Hashimoto's thyroiditis. Although the subjects were in self-proclaimed good health, 3.6% were found to have hypothyroidism (overt disease in 1.3%) and 1.9% had hyperthyroidism (overt disease in 0.4%). These patients were older than the euthyroid subjects and were mostly positive for thyroid peroxidase (TPO) antibodies. Oestrogen use was associated with a lower rate of hyperthyroidism [relative risk (RR) 0.169; 95% confidence interval (CI) 0.06-0.52], whereas having been pregnant was associated with a higher relative risk for hyperthyroidism (RR 6.88; 95% CI 1.50-30.96). Of the 759 euthyroid subjects, 24% had TPO antibodies. Smoking and oestrogen use were negatively correlated with the presence of TPO antibodies. In the euthyroid subjects, TPO antibody titre correlated positively with TSH levels (r = 0.386; P < 0.001).
The high prevalence of evidence for autoimmune thyroiditis at baseline supports the importance of genetic factors in its pathogenesis. The co-occurrence of Hashimoto's thyroiditis and Graves' disease within one family suggests a common genetic basis for these diseases. Oestrogen use is associated with a lower risk, and pregnancy with a higher risk for developing hyperthyroidism. The positive correlation between TPO antibody titres and TSH levels in euthyroid subjects suggests that TPO antibodies are indeed a marker of future thyroid failure.
自身免疫性甲状腺疾病（AITD）是一种常见疾病，尤其在女性中多见，其发病机制涉及遗传和环境因素。我们希望更深入了解各种环境因素的作用。因此，我们对有患AITD风险的人群，如AITD患者的健康女性亲属，开展了一项大型前瞻性队列研究。在此我们报告他们的基线特征。
仅纳入有记录的AITD患者的一级或二级女性亲属。
通过问卷调查评估吸烟习惯、雌激素使用情况、妊娠史和碘暴露情况，并将其与甲状腺功能及抗体状态相关联。
在803名研究对象中，440名来自有不止一名有记录的AITD患者的家庭。在这些家庭中，33%有记录显示同时存在格雷夫斯病和桥本甲状腺炎病例。尽管研究对象自称健康状况良好，但发现3.6%有甲状腺功能减退（显性疾病占1.3%），1.9%有甲状腺功能亢进（显性疾病占0.4%）。这些患者比甲状腺功能正常的研究对象年龄更大，且大多甲状腺过氧化物酶（TPO）抗体呈阳性。使用雌激素与甲状腺功能亢进发生率较低相关[相对风险（RR）0.169；95%置信区间（CI）0.06 - 0.52]，而怀孕与甲状腺功能亢进的相对风险较高相关（RR 6.88；95% CI 1.50 - 30.96）。在759名甲状腺功能正常的研究对象中，24%有TPO抗体。吸烟和雌激素使用与TPO抗体的存在呈负相关。在甲状腺功能正常的研究对象中，TPO抗体滴度与促甲状腺激素（TSH）水平呈正相关（r = 0.386；P < 0.001）。
基线时自身免疫性甲状腺炎证据的高患病率支持了遗传因素在其发病机制中的重要性。桥本甲状腺炎和格雷夫斯病在一个家庭中的共同出现提示这些疾病有共同的遗传基础。使用雌激素与发生甲状腺功能亢进的风险较低相关，而怀孕与发生甲状腺功能亢进的风险较高相关。甲状腺功能正常的研究对象中TPO抗体滴度与TSH水平的正相关表明TPO抗体确实是未来甲状腺功能减退的一个标志物。
