Goldman M B, Monson R R, Maloof F
Department of Epidemiology, Harvard School of Public Health, Boston 02115.
Cancer Res. 1990 Apr 15;50(8):2283-9.
A retrospective follow-up study of 7338 women with either nontoxic nodular goiter, thyroid adenoma, hyperthyroidism, hypothyroidism, Hashimoto's thyroiditis, or no thyroid disease was conducted. All women patients at the Massachusetts General Hospital Thyroid Clinic who were seen between 1925 and 1974 and who were treated for a minimum of 1 year were traced. A total of 2231 women (30.4%) were dead and 2012 women (27.4%) were alive as of December 31, 1978. Partial follow-up information was available for the remaining 3095 women (42.2%). The average length of follow-up was 15.2 years. When losses to follow-up were withdrawn at the time of their loss, the standardized mortality ratios (SMR) for all causes of death were 1.2 [95% confidence interval (CI), 1.1-1.3] for women with nontoxic nodular goiter, 1.2 (95% CI 1.0-1.3) for those with thyroid adenoma, 1.4 (95% CI 1.3-1.5) for women with hyperthyroidism, 1.5 (95% CI 1.3-1.7) for hypothyroid women, 1.2 (95% CI 0.9-1.5) for those with Hashimoto's thyroiditis, and 1.5 (95% CI 1.4-1.6) for those without thyroid disease. For deaths from all cancers, the standardized mortality ratios were 1.5 (95% CI 1.2-1.8) for women with nontoxic nodular goiter, 1.5 (95% CI 1.1-1.9) for those with thyroid adenoma, 1.2 (95% CI 1.0-1.4) for women with hyperthyroidism, 1.0 (95% CI 0.7-1.4) for the hypothyroid women, 1.2 (95% CI 0.7-2.1) for those with Hashimoto's thyroiditis, and 1.3 (95% CI 1.0-1.5) for those women without thyroid disease. When specific cancer sites were studied, excess numbers of deaths were observed from breast cancer in women with nontoxic nodular goiter (SMR = 1.6, 95% CI 1.0-2.6) and from lymphatic and hematopoietic cancer in women with nontoxic nodular goiter (SMR = 2.4, 95% CI 1.2-4.3) and thyroid adenoma (SMR = 2.7, 95% CI 1.1-5.2). An increase in thyroid cancer risk was observed in women with thyroid adenoma (SMR = 11.7, 95% CI 1.3-42.1) but was based on only two deaths. In hyperthyroid women, statistically significant increases in the number of deaths were observed from pancreatic cancer (SMR = 2.6, 95% CI 1.4-4.3) and respiratory cancer (SMR = 2.2, 95% CI 1.3-3.5), but not breast cancer (SMR = 1.3, 95% CI 0.8-1.8). When the data were stratified by the time between the onset of thyroid symptoms and death, a nonsignificant excess number of cancer deaths was observed in hyperthyroid women who died 20 or more years after their symptoms began.(ABSTRACT TRUNCATED AT 400 WORDS)
对7338名患有非毒性结节性甲状腺肿、甲状腺腺瘤、甲状腺功能亢进、甲状腺功能减退、桥本甲状腺炎或无甲状腺疾病的女性进行了一项回顾性随访研究。对1925年至1974年间在马萨诸塞州总医院甲状腺诊所就诊且接受至少1年治疗的所有女性患者进行了追踪。截至1978年12月31日，共有2231名女性（30.4%）死亡，2012名女性（27.4%）存活。其余3095名女性（42.2%）有部分随访信息。平均随访时间为15.2年。当随访失访者在失访时被排除后，非毒性结节性甲状腺肿女性所有死因的标准化死亡比（SMR）为1.2[95%置信区间（CI），1.1 - 1.3]，甲状腺腺瘤女性为1.2（95% CI 1.0 - 1.3），甲状腺功能亢进女性为1.4（95% CI 1.3 - 1.5），甲状腺功能减退女性为1.5（95% CI 1.3 - 1.7），桥本甲状腺炎女性为1.2（95% CI 0.9 - 1.5），无甲状腺疾病女性为1.5（95% CI 1.4 - 1.6）。对于所有癌症导致的死亡，非毒性结节性甲状腺肿女性的标准化死亡比为1.5（95% CI 1.2 - 1.8），甲状腺腺瘤女性为1.5（95% CI 1.1 - 1.9），甲状腺功能亢进女性为1.2（95% CI 1.0 - 1.4），甲状腺功能减退女性为1.0（95% CI 0.7 - 1.4），桥本甲状腺炎女性为1.2（95% CI 0.7 - 2.1），无甲状腺疾病女性为1.3（95% CI 1.0 - 1.5）。当研究特定癌症部位时，观察到非毒性结节性甲状腺肿女性乳腺癌死亡人数过多（SMR = 1.6，95% CI 1.0 - 2.6），非毒性结节性甲状腺肿女性以及甲状腺腺瘤女性淋巴和造血系统癌症死亡人数过多（非毒性结节性甲状腺肿SMR = 2.4，95% CI 1.2 - 4.3；甲状腺腺瘤SMR = 2.7，95% CI 1.1 - 5.2）。甲状腺腺瘤女性甲状腺癌风险增加（SMR = 11.7，95% CI 1.3 - 42.1），但仅基于两例死亡。在甲状腺功能亢进女性中，观察到胰腺癌（SMR = 2.6，95% CI 1.4 - 4.3）和呼吸道癌症（SMR = 2.2，95% CI 1.3 - 3.5）死亡人数有统计学显著增加，但乳腺癌无增加（SMR = 1.3，95% CI 0.8 - 1.8）。当数据按甲状腺症状出现至死亡的时间分层时，甲状腺症状出现20年或更久后死亡的甲状腺功能亢进女性中观察到癌症死亡人数非显著过多。（摘要截断于400字）
