Department of Clinical and Molecular Endocrinology and Oncology, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy.
Eur J Endocrinol. 2012 Sep;167(3):295-9. doi: 10.1530/EJE-12-0585. Epub 2012 Jul 16.
Over the past five years several meta-analyses have evaluated the cardiovascular mortality in patients with hyperthyroidism. They assessed various studies in which different inclusion criteria were used for the analysis of the cardiovascular mortality. More selective criteria have been used in recent meta-analyses. Only prospective cohort studies were included and only cohorts using second and third generation TSH assays were chosen. In addition, only the studies where the TSH evaluation was repeated during the follow-up were selected. The results of these recent meta-analyses provide evidence that overt and subclinical hyperthyroidism, particularly in patients with undetectable serum TSH, may increase the cardiovascular mortality. However, still today, the results remain inconclusive and not sufficient enough to recommend treatment for patients with low-detectable serum TSH. The high cardiovascular risk and mortality in presence of thyroid hormone excess suggest that this dysfunction is an important health problem and requires guidelines for the treatment of patients at high cardiovascular risk. Rigorous studies are necessary to evaluate the effects of the various causes of hyperthyroidism on the clinical outcomes. Randomized controlled clinical trials are needed to assess the benefits of treatment to improve the cardiovascular mortality and morbidity of mild and overt hyperthyroidism.
在过去的五年中，有几项荟萃分析评估了甲状腺功能亢进症患者的心血管死亡率。他们评估了各种研究，这些研究对心血管死亡率的分析使用了不同的纳入标准。最近的荟萃分析使用了更具选择性的标准。仅纳入前瞻性队列研究，并且仅选择使用第二代和第三代 TSH 检测的队列。此外，仅选择在随访期间重复进行 TSH 评估的研究。这些最近的荟萃分析结果表明，显性和亚临床甲状腺功能亢进症，特别是血清 TSH 无法检测到的患者，可能会增加心血管死亡率。然而，时至今日，结果仍然不确定，不足以推荐对血清 TSH 低检测值的患者进行治疗。甲状腺激素过多存在高心血管风险和死亡率表明，这种功能障碍是一个重要的健康问题，需要为高心血管风险患者的治疗制定指南。需要进行严格的研究来评估各种原因引起的甲状腺功能亢进症对临床结果的影响。需要进行随机对照临床试验来评估治疗的益处，以改善轻度和显性甲状腺功能亢进症的心血管死亡率和发病率。
