儿童/青少年肥胖中血清促甲状腺激素升高的患病率以及亚组中自身免疫性甲状腺疾病的患病率。
The prevalence of elevated serum thyroid-stimulating hormone in childhood/adolescent obesity and of autoimmune thyroid diseases in a subgroup.
作者信息
Bhowmick Samar K, Dasari Gayathri, Levens Kara L, Rettig Kenneth R
机构信息
Division of Endocrine and Metabolic Disease, University of South Alabama College of Medicine, 2451 Fillingim St., Suite 212, Mobile, AL 36617-2293, USA.
出版信息
J Natl Med Assoc. 2007 Jul;99(7):773-6.
OBJECTIVES
- To ascertain the frequency of elevated thyroid-stimulating hormone (TSH) level in obese children and adolescents and 2) to determine the prevalence of positive thyroid antibodies in the subgroup of obese children with elevated serum TSH concentration.
METHODS
Retrospective chart review and prospective observation of 308 children, ages 6-17 years, with nonorganic, nonsyndromic obesity with BMI > 97th percentile. The control population consisted of 286 nonobese, otherwise-healthy children of the same age range. Thyroid function tests (free T4 or T4 with TSH) were obtained on all patients in both groups. Thyroid antibodies (thyroid peroxidase and thyroglobulin) were determined among those with elevated TSH levels.
RESULTS
Elevated TSH levels of > 4 uIU/ml (reference interval 0.4-4) were noted in 36 patients within the obese group (11.7%) but only two in the control group (< 0.7%). Five out of the 36 in the obese subgroup with elevated TSH levels had positive thyroid antibodies (14%). All five subjects in the obese subgroup with positive thyroid antibodies had TSH levels >7.4 uIU/ml, with an average of 9.8 uIU/ml. Thirty-one children in the obese subgroup with negative thyroid antibodies had TSH levels < 6.7 uIU/ml (average 5.33 uIU/ml).
CONCLUSION
A higher prevalence of TSH elevation was observed in the obese group (11.7%) than in the control group (0.7%). Positive thyroid peroxidase and thyroglobulin antibodies were observed in higher frequency in the obese subgroup with an elevated TSH level. The obese subgroup with positive thyroid antibodies also had higher TSH levels. Therefore, some instances of high TSH, especially those associated with antibodies, are likely due, at least in part, to thyroid disease, and others (possibly a majority) may be due to obesity, not its cause. It remains to be seen whether any children with mild TSH elevation benefit from thyroid hormone treatment.
目的
1）确定肥胖儿童和青少年中促甲状腺激素（TSH）水平升高的频率；2）确定血清TSH浓度升高的肥胖儿童亚组中甲状腺抗体阳性的患病率。
方法
对308名6至17岁、患有非器质性、非综合征性肥胖且BMI>第97百分位数的儿童进行回顾性病历审查和前瞻性观察。对照组由286名同年龄范围的非肥胖、其他方面健康的儿童组成。两组所有患者均进行了甲状腺功能测试（游离T4或T4加TSH）。对TSH水平升高的患者测定甲状腺抗体（甲状腺过氧化物酶和甲状腺球蛋白）。
结果
肥胖组中有36名患者（11.7%）的TSH水平升高至>4 uIU/ml（参考区间0.4 - 4），而对照组中只有2名患者（<0.7%）。肥胖亚组中TSH水平升高的36名患者中有5名甲状腺抗体呈阳性（14%）。肥胖亚组中甲状腺抗体阳性的所有5名受试者的TSH水平>7.4 uIU/ml，平均为9.8 uIU/ml。肥胖亚组中甲状腺抗体阴性的31名儿童的TSH水平<6.7 uIU/ml（平均5.33 uIU/ml）。
结论
肥胖组中TSH升高的患病率（11.7%）高于对照组（0.7%）。TSH水平升高的肥胖亚组中甲状腺过氧化物酶和甲状腺球蛋白抗体阳性的频率更高。甲状腺抗体阳性的肥胖亚组的TSH水平也更高。因此，一些TSH升高的情况，尤其是那些与抗体相关的情况，可能至少部分归因于甲状腺疾病，而其他情况（可能是大多数）可能归因于肥胖，而非肥胖的原因。轻度TSH升高的儿童是否能从甲状腺激素治疗中获益仍有待观察。
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