Morganti S, Ceda G P, Saccani M, Milli B, Ugolotti D, Prampolini R, Maggio M, Valenti G, Ceresini G
Department of Internal Medicine and Biomedical Sciences, Section of Geriatrics, Endocrine-Metabolic Unit, University of Parma, 43100 Parma, Italy.
J Endocrinol Invest. 2005;28(11 Suppl Proceedings):101-4.
Thyroid diseases are more prevalent in females. This notion is mostly derived from studies conducted in adult subjects, but the knowledge of the relationship between sex and thyroid disease is becoming important for the epidemiological study of aging population. Aging has been proposed to represent a trigger for the development of autoimmune phenomena resulting in the production of both organ- and non-organ-specific antibodies. Studies on the relationship between sex and thyroid autoimmunity in elderly subjects have shown that the age-related prevalence of antithyroid autoantibodies is greater in women >60 yr of age. An increased prevalence of hypothyroidism has been demonstrated in the elderly population. Several factors may affect prevalence, but virtually all studies report higher prevalence rates for either overt or subclinical hypothyroidism in women with advancing age. This gender-related difference, however, has not been demonstrated for hospitalized patients. Difficulties are encountered in the attempt to estimate a sex-related difference in the prevalence of hyperthyroidism in elderly subjects. In most cases, Graves' disease and toxic multinodular goiter represent the cause of the disease with relative proportions depending on iodine intake. However, data on the prevalence of this disorder and on its sex-related frequency are significantly affected by underlying nodularity and functional autonomy. This phenomenon may be even more pronounced when excess iodine intake occurs and when patients are treated with iodine-containing drugs and thyroid hormone therapy. Subclinical hyperthyroidism is more common in women than in men, especially in subjects >70 yr. Both overt and subclinical hyperthyroidism arise from underlying thyroid nodular disease. The low-T3 syndrome is common in the elderly. Due to the fact that the low-T3 syndrome is often derived from underlying diseases, it is difficult do define a sex-related difference in its prevalence. However, in unselected elderly home-dwellers, an independent association of low-T3 syndrome with male gender has been shown. Aging represents an important factor to define the aggressiveness of thyroid carcinomas. Both follicular and anaplastic histotypes of thyroid cancer are more frequently found in elderly subjects. In aging subjects, male sex seems to be highly correlated with the risk of thyroid cancer. In conclusion, epidemiological data from the aging population confirms that men are less affected by thyroid disease than women. However, male sex may represent a risk factor for thyroid cancer in elderly population and this observation should be carefully considered in the evaluation of thyroid nodules in the elderly.
甲状腺疾病在女性中更为普遍。这一观点主要源于对成年受试者的研究，但性别与甲状腺疾病之间关系的知识对于老年人群的流行病学研究正变得愈发重要。衰老被认为是自身免疫现象发展的触发因素，会导致器官特异性和非器官特异性抗体的产生。对老年受试者中性别与甲状腺自身免疫关系的研究表明，年龄相关的抗甲状腺自身抗体患病率在60岁以上女性中更高。在老年人群中，甲状腺功能减退症的患病率有所上升。有几个因素可能会影响患病率，但几乎所有研究都报告，随着年龄增长，无论是显性还是亚临床甲状腺功能减退症，女性的患病率都更高。然而，这种性别差异在住院患者中并未得到证实。在试图估计老年受试者中甲状腺功能亢进症患病率的性别差异时会遇到困难。在大多数情况下，格雷夫斯病和毒性多结节性甲状腺肿是该病的病因，其相对比例取决于碘摄入量。然而，这种疾病的患病率及其性别相关频率的数据受到潜在结节性和功能自主性的显著影响。当碘摄入过量以及患者接受含碘药物和甲状腺激素治疗时，这种现象可能会更加明显。亚临床甲状腺功能亢进症在女性中比在男性中更常见，尤其是在70岁以上的人群中。显性和亚临床甲状腺功能亢进症均源于潜在的甲状腺结节疾病。低T3综合征在老年人中很常见。由于低T3综合征通常源于潜在疾病，因此很难确定其患病率的性别差异。然而，在未经过挑选的老年居家者中，已表明低T3综合征与男性性别存在独立关联。衰老代表了确定甲状腺癌侵袭性的一个重要因素。甲状腺癌的滤泡型和间变组织学类型在老年受试者中更为常见。在老年受试者中，男性性别似乎与甲状腺癌风险高度相关。总之，老年人群的流行病学数据证实，男性受甲状腺疾病影响比女性小。然而，男性性别可能是老年人群甲状腺癌的一个风险因素，在评估老年患者的甲状腺结节时应仔细考虑这一观察结果。
