Department of Endocrinology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Thyroid. 2012 Dec;22(12):1236-43. doi: 10.1089/thy.2011.0200. Epub 2012 Oct 19.
Thyrotoxicosis and hypothyroidism are associated with fatigue. Here we studied euthyroid subjects to determine if there was a relationship between serum thyrotropin (TSH), free thyroxine (FT(4)) and thyroperoxidase antibodies and fatigue.
A total of 5897 participants of the Nijmegen Biomedical Study received a questionnaire and serum TSH (normal range 0.4-4.0 mIU/L) and FT(4) (normal range 8-22 pmol/L) were measured. Fatigue was evaluated by the RAND-36 and the shortened fatigue questionnaire (SFQ).
Euthyroid subjects with a serum TSH level of 0.4-1.0 mIU/L had a lower RAND-36 vitality score (65.2 vs. 66.8; regression coefficient (RC) -1.6 [95% confidence interval (CI) -2.6 to -0.5]; p=0.005) and a higher SFQ score (11.7 vs. 11.0; RC 0.6 [CI 0.2-1.0]; p=0.004) than those with a TSH of 1.0-2.0 mIU/L. Those with a serum FT(4) of 18.5-22 pmol/L reported fatigue more often (52.5% vs. 33.3%; relative risk (RR) 1.4 [CI 1.0-1.9]; p=0.03), had a lower RAND-36 vitality score (61.7 vs. 66.6; RC -4.4 [CI -8.1 to -0.6]; p=0.02) and a higher SFQ score (13.2 vs. 11.0; RC 1.9 [CI 0.4-3.3]; p=0.01) than subjects with a FT(4) level of 11.5-15 pmol/L. In comparison to euthyroid subjects without known thyroid disease, euthyroid subjects with previously known thyroid disease reported fatigue more often (52.3% vs. 34.0%; RR 1.3 [CI 1.0-1.5]; p=0.025), had a lower RAND-36 vitality score (61.4 vs. 66.3; RC -2.9 [CI -5.3 to -0.6]; p=0.015) and a higher SFQ score (13.7 vs. 11.1; RC 1.4 [CI 0.5-2.3]; p=0.002).
In euthyroid individuals without a history of thyroid disease, there is a modest relationship between thyroid function and fatigue with subjects having an apparently higher production of T(4) experiencing more fatigue. Subjects with a history of thyroid disease, but with normal TSH and FT(4) concentrations, experience more fatigue than the general population. The reasons for this are unclear, but subtle abnormalities in the dynamics of thyroid hormone secretion should be considered.
甲状腺功能亢进症和甲状腺功能减退症与疲劳有关。在这里，我们研究了甲状腺功能正常的受试者，以确定血清促甲状腺激素（TSH）、游离甲状腺素（FT(4)）和甲状腺过氧化物酶抗体与疲劳之间是否存在关系。
共 5897 名尼梅根生物医学研究的参与者接受了问卷调查，并测量了血清 TSH（正常范围 0.4-4.0 mIU/L）和 FT(4)（正常范围 8-22 pmol/L）。疲劳通过 RAND-36 和简化疲劳问卷（SFQ）进行评估。
血清 TSH 水平为 0.4-1.0 mIU/L 的甲状腺功能正常受试者的 RAND-36 活力评分较低（65.2 比 66.8；回归系数（RC）-1.6 [95%置信区间（CI）-2.6 至-0.5]；p=0.005），SFQ 评分较高（11.7 比 11.0；RC 0.6 [CI 0.2-1.0]；p=0.004），而 TSH 为 1.0-2.0 mIU/L 的受试者则较低。血清 FT(4) 为 18.5-22 pmol/L 的受试者报告疲劳的频率更高（52.5%比 33.3%；相对风险（RR）1.4 [CI 1.0-1.9]；p=0.03），RAND-36 活力评分较低（61.7 比 66.6；RC -4.4 [CI -8.1 至-0.6]；p=0.02），SFQ 评分较高（13.2 比 11.0；RC 1.9 [CI 0.4-3.3]；p=0.01），而 FT(4) 水平为 11.5-15 pmol/L 的受试者则较低。与无已知甲状腺疾病的甲状腺功能正常受试者相比，既往有甲状腺疾病的甲状腺功能正常受试者报告疲劳的频率更高（52.3%比 34.0%；RR 1.3 [CI 1.0-1.5]；p=0.025），RAND-36 活力评分较低（61.4 比 66.3；RC -2.9 [CI -5.3 至-0.6]；p=0.015），SFQ 评分较高（13.7 比 11.1；RC 1.4 [CI 0.5-2.3]；p=0.002）。
在无甲状腺疾病病史的甲状腺功能正常个体中，甲状腺功能与疲劳之间存在适度的关系，表现为 T(4) 产生量较高的受试者疲劳程度更高。有甲状腺疾病病史但 TSH 和 FT(4) 浓度正常的受试者比一般人群更容易疲劳。其原因尚不清楚，但应考虑甲状腺激素分泌动力学的细微异常。
