Díez Juan J
Department of Endocrinology, Hospital La Paz, Madrid, Spain.
Gerontology. 2003 Sep-Oct;49(5):316-23. doi: 10.1159/000071713.
Hyperthyroidism is a common disease in the elderly. Although some studies on the prevalence of this thyroid disorder have been performed in the aged population, several aspects of hyperthyroidism, such as etiology and treatment effectiveness, have not been fully characterized in large series of aged patients.
The aims of the present study were to determine the frequency of the diverse etiologies of hyperthyroidism, and to assess the effectiveness of therapy in adult patients older than 55 years.
We performed a descriptive, observational, cross-sectional study in the setting of a hospital endocrinology clinic. We studied a group of 313 patients with hyperthyroidism. There were 246 women (78.6%, age 67.02 +/- 8.35 years) and 67 men (21.4% age 63.34 +/- 7.63 years). Overt hyperthyroidism was diagnosed in 167 patients (53.4%) and subclinical hyperthyroidism in the remaining 146 subjects (46.6%). In every patient we studied: the etiology; presence or absence of goiter; time of evolution from diagnosis; previously and presently used treatments; current thyroid functional status (free thyroxine and thyrotropin concentrations); adequacy of disease control, and thyroid autoimmune status.
The different etiologies of hyperthyroidism were as follows: toxic multinodular goiter 43.1%; Graves' disease 21.4%; iatrogenic thyrotoxicosis 16.0%; toxic adenoma 11.8%; iodine-induced thyrotoxicosis 1.2%; subacute thyroiditis 1.0%; painless thyroiditis 0.3%; factitious thyrotoxicosis 0.3%; TSH-secreting pituitary adenoma 0.6%, and unknown etiology 3.8%. Etiology was related to age, sex, presence of goiter, degree of hyperthyroidism and autoimmune status. 77.6% of patients had been diagnosed in the last 5 years, and 91.3% in the last 10 years. Preferred therapies were thionamide drugs in patients with Graves' disease and radioiodine in patients with hyperthyroidism due to nodular disease. Surgery was performed in a limited number of patients. Periodic follow-up was used in patients with subclinical hyperthyroidism. Control of the disease was adequate in 65.3% and inadequate in 34.7% of patients who received any kind of previous therapy. In this group of patients, logistic regression analysis showed that the probability of attaining good control of hyperthyroidism was greater in patients with overt thyrotoxicosis compared to patients with subclinical thyrotoxicosis.
In patients older than 55 years, toxic multinodular goiter is the most frequent etiology of spontaneous hyperthyroidism, followed by Graves' disease and toxic adenoma. Most patients with thyroid hyperfunction can be adequately controlled, provided that effective therapy is administered. Patients with overt hyperthyroidism seem to have a higher probability of attaining adequate control of their disease than patients with subclinical hyperthyroidism, regardless of age, sex or etiology.
甲状腺功能亢进症在老年人中是一种常见疾病。尽管已经在老年人群中对这种甲状腺疾病的患病率进行了一些研究，但甲状腺功能亢进症的几个方面，如病因和治疗效果，在大量老年患者中尚未得到充分描述。
本研究的目的是确定甲状腺功能亢进症不同病因的发生率，并评估55岁以上成年患者的治疗效果。
我们在一家医院内分泌门诊进行了一项描述性、观察性横断面研究。我们研究了一组313例甲状腺功能亢进症患者。其中女性246例（78.6%，年龄67.02±8.35岁），男性67例（21.4%，年龄63.34±7.63岁）。167例患者（53.4%）诊断为显性甲状腺功能亢进症，其余146例患者（46.6%）诊断为亚临床甲状腺功能亢进症。我们对每位患者研究了：病因；有无甲状腺肿；从诊断开始的病程时间；既往和目前使用的治疗方法；当前甲状腺功能状态（游离甲状腺素和促甲状腺激素浓度）；疾病控制的充分程度，以及甲状腺自身免疫状态。
甲状腺功能亢进症的不同病因如下：毒性多结节性甲状腺肿43.1%；格雷夫斯病21.4%；医源性甲状腺毒症16.0%；毒性腺瘤11.8%；碘致甲状腺毒症1.2%；亚急性甲状腺炎1.0%；无痛性甲状腺炎0.3%；人为甲状腺毒症0.3%；分泌促甲状腺激素的垂体腺瘤0.6%，病因不明3.8%。病因与年龄、性别、甲状腺肿的存在、甲状腺功能亢进程度和自身免疫状态有关。77.6%的患者在过去5年中被诊断，91.3%的患者在过去10年中被诊断。格雷夫斯病患者首选硫酰胺类药物治疗，结节性疾病所致甲状腺功能亢进症患者首选放射性碘治疗。少数患者接受了手术治疗。亚临床甲状腺功能亢进症患者采用定期随访。在接受过任何先前治疗的患者中，65.3%的患者疾病得到充分控制，34.7%的患者控制不佳。在这组患者中，逻辑回归分析显示，与亚临床甲状腺毒症患者相比，显性甲状腺毒症患者实现甲状腺功能亢进症良好控制的概率更大。
在55岁以上的患者中，毒性多结节性甲状腺肿是自发性甲状腺功能亢进症最常见的病因，其次是格雷夫斯病和毒性腺瘤。大多数甲状腺功能亢进患者，只要给予有效治疗，病情可以得到充分控制。无论年龄、性别或病因如何，显性甲状腺功能亢进症患者似乎比亚临床甲状腺功能亢进症患者更有可能实现疾病的充分控制。
