Giusti Massimo, Mortara Lorenzo, Degrandi Roberta, Cecoli Francesca, Mussap Michele, Rodriguez Guido, Ferone Diego, Minuto Francesco
Clinica Endocrinologica, Azienda Ospedaliera Universitaria "San Martino", Genoa, Italy.
Thyroid Res. 2008 Sep 29;1(1):2. doi: 10.1186/1756-6614-1-2.
Hyperthyroidism seems to increase metabolic and cardiovascular risk, while the effects of sub-clinical hyperthyroidism are controversial. We evaluated metabolic and cardiovascular parameters in differentiated thyroid carcinoma (DTC) patients with suppressed thyrotropin (TSH) due to levo-thyroxine (L-T4) therapy. We studied DTC patients and, as a control group, patients with a history of surgery for non-malignant thyroid pathology. Significantly higher insulin and lower HDL-cholesterol levels were recorded in DTC subjects. In both groups, insulin levels were significantly related with body mass index (BMI) but not with age or L-T4 dosage. In DTC patients, a significant negative correlation was seen between HDL-cholesterol and BMI or L-T4 dosage. In both groups, intima-media thickness (IMT) correlated positively with age, BMI, glucose levels and systolic blood pressure. In DTC patients, increased IMT was significantly correlated with glycated hemoglobin (HbA1c), cholesterol and triglycerides. In DTC patients, C-reactive protein correlated positively with insulin, insulin resistance, triglycerides and systolic blood pressure, and negatively with HDL-cholesterol. In both DTC and control subjects, fibrinogen correlated positively with age, BMI, increased IMT, HbA1c and systolic blood pressure. In DTC subjects, plasma fibrinogen concentrations correlated positively with insulin resistance, cholesterol and LDL-cholesterol, and negatively with TSH levels. Our data confirm that the favorable evolution of DTC can be impaired by a high incidence of abnormal metabolic and cardiovascular data that are, at least in part, related to L-T4 therapy. These findings underline the need for adequate L-T4 titration.
甲状腺功能亢进似乎会增加代谢和心血管风险，而亚临床甲状腺功能亢进的影响则存在争议。我们评估了因左甲状腺素（L-T4）治疗导致促甲状腺激素（TSH）被抑制的分化型甲状腺癌（DTC）患者的代谢和心血管参数。我们研究了DTC患者，并将有非恶性甲状腺疾病手术史的患者作为对照组。DTC患者的胰岛素水平显著升高，高密度脂蛋白胆固醇水平降低。在两组中，胰岛素水平均与体重指数（BMI）显著相关，但与年龄或L-T4剂量无关。在DTC患者中，高密度脂蛋白胆固醇与BMI或L-T4剂量之间存在显著负相关。在两组中，内膜中层厚度（IMT）与年龄、BMI、血糖水平和收缩压呈正相关。在DTC患者中，IMT增加与糖化血红蛋白（HbA1c）、胆固醇和甘油三酯显著相关。在DTC患者中，C反应蛋白与胰岛素、胰岛素抵抗、甘油三酯和收缩压呈正相关，与高密度脂蛋白胆固醇呈负相关。在DTC患者和对照组中，纤维蛋白原与年龄、BMI、IMT增加、HbA1c和收缩压呈正相关。在DTC患者中，血浆纤维蛋白原浓度与胰岛素抵抗、胆固醇和低密度脂蛋白胆固醇呈正相关，与TSH水平呈负相关。我们的数据证实，DTC的良好转归可能会因异常代谢和心血管数据的高发生率而受损，这些数据至少部分与L-T4治疗有关。这些发现强调了进行适当的L-T4滴定的必要性。
