Hasegawa M, Iino S, Ito K, Hamada N
Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
Nihon Naibunpi Gakkai Zasshi. 1990 Mar 20;66(3):207-17. doi: 10.1507/endocrine1927.66.3_207.
In order to discover whether or not thyroid function in patients with Hashimoto's disease will move toward hypothyroidism with age, we investigated the thyroid function and antithyroid antibody titers at the initial examination and 5 years later in 181 patients with goitrous Hashimoto's thyroiditis. Pregnant patients and those within 1 year of the postpartum period were excluded. The thyroid function was assessed before medication or at least one month after stopping it. At the initial examination, 52% (94 cases) of the cases were euthyroid, 24% (44 cases) were subclinically hypothyroid and 24% (43 cases) were hypothyroid. It was not observed whether the incidence of hypothyroidism tended to be greater in older patients or in patients with longer duration of illness. Five years later, 68% of euthyroid patients at the initial examination remained in euthyroid state, 18% had become subclinically hypothyroid, and 9% were hypothyroid. The thyroid function was not evaluated in 5% of the patients because they were under treatment with 1-thyroxine. In the patients with subclinical hypothyroidism at the initial examination, 30% had become euthyroid, 23% remained subclinically hypothyroid, 32% had become hypothyroid and 16% were not evaluated. Thirty percent of the patients with hypothyroidism at the initial examination had become euthyroid, 7% were subclinically hypothyroid, 28% remained hypothyroid and 35% were not evaluated. The higher the titer of TGHA, the higher the percentage of hypothyroidism at the first examination. A similar but much stronger tendency was observed in the patients with a higher titer of MCHA. In the patients with a higher titer of TGHA, the number of hypothyroid patients approximately doubled after 5 years, although such a tendency was not observed in the patients with a higher titer of MCHA. In patients with persistent hypothyroidism, the age was significantly higher, the serum concentration of T3 lower and the titer of TGHA at the initial examination and MCHA 5 years later higher than in the patients with transient hypothyroidism. The titer of MCHA was significantly decreased 5 years later in patients with transient hypothyroidism. From these results, it is indicated that in patients with goitrous hypothyroidism, the incidence of hypothyroidism was higher in the cases with high titers of antithyroid antibody than in those with low titers, and that in the patients with transient hypothyroidism, the age was lower, the serum level of T3 higher and the titer of TGHA lower than in the cases with permanent hypothyroidism.(ABSTRACT TRUNCATED AT 400 WORDS)
为了探究桥本氏病患者的甲状腺功能是否会随着年龄增长而走向甲状腺功能减退，我们对181例甲状腺肿性桥本氏甲状腺炎患者在初诊时及5年后的甲状腺功能和抗甲状腺抗体滴度进行了调查。排除了孕妇及产后1年内的患者。在用药前或停药至少1个月后评估甲状腺功能。初诊时，52%（94例）患者甲状腺功能正常，24%（44例）为亚临床甲状腺功能减退，24%（43例）为甲状腺功能减退。未观察到老年患者或病程较长患者中甲状腺功能减退的发生率是否更高。5年后，初诊时甲状腺功能正常的患者中，68%仍保持甲状腺功能正常，18%变为亚临床甲状腺功能减退，9%为甲状腺功能减退。5%的患者因正在接受左旋甲状腺素治疗而未评估甲状腺功能。初诊时亚临床甲状腺功能减退的患者中，30%恢复甲状腺功能正常，23%仍为亚临床甲状腺功能减退，32%变为甲状腺功能减退，16%未评估。初诊时甲状腺功能减退的患者中，30%恢复甲状腺功能正常，7%为亚临床甲状腺功能减退，28%仍为甲状腺功能减退，35%未评估。甲状腺球蛋白抗体（TGHA）滴度越高，初诊时甲状腺功能减退的百分比越高。在甲状腺微粒体抗体（MCHA）滴度较高的患者中观察到类似但更强的趋势。TGHA滴度较高的患者中，甲状腺功能减退患者数量在5年后约增加一倍，而MCHA滴度较高的患者中未观察到这种趋势。持续性甲状腺功能减退患者的年龄显著更高，初诊时血清T3浓度更低，5年后TGHA和MCHA滴度更高，而短暂性甲状腺功能减退患者5年后MCHA滴度显著降低。从这些结果表明，甲状腺肿性甲状腺功能减退患者中，抗甲状腺抗体滴度高的患者甲状腺功能减退的发生率高于滴度低的患者，且短暂性甲状腺功能减退患者的年龄更低，血清T3水平更高，TGHA滴度低于永久性甲状腺功能减退患者。（摘要截选至400字）
