Klaver Elise I, van Loon Hannah C M, Stienstra Riejanne, Links Thera P, Keers Joost C, Kema Ido P, Kobold Anneke C Muller, van der Klauw Melanie M, Wolffenbuttel Bruce H R
1 Department of Endocrinology, University of Groningen , Groningen, The Netherlands .
Thyroid. 2013 Sep;23(9):1066-73. doi: 10.1089/thy.2013.0017.
Thyroid disorders are prevalent in Western society, yet many subjects experience limited symptoms at diagnosis, especially in hypothyroidism. We hypothesize that health-related quality of life (HR-QOL) is more severely impaired in subjects with more abnormal thyroid hormone function tests.
This is a cross-sectional study of Dutch adults participating in the LifeLines Cohort Study between December 2009 and August 2010. In 9491 Western European participants (median age 45 years; 3993 men and 5498 women), without current or former use of thyroid medication, we compared HR-QOL using the RAND 36-Item Health Survey between subjects with normal thyrotropin (TSH) values and subjects with disturbed thyroid hormone status (serum TSH, free thyroxine, and free triiodothyronine). The influence of possible confounders (age, smoking, co-morbidity) on HR-QOL was evaluated as well.
Suppressed TSH values (TSH < 0.5 mU/L) were found in 114 (1.2%), while 8334 (88.8%) had TSH within the normal range, 973 participants (10.3%) had TSH between 4 and 10 mU/L, and 70 (0.7%) had TSH > 10 mU/L. Men had a higher HR-QOL than women (70-92 vs. 65-89; p < 0.001), except for the domain "general health" (72 vs. 72; p = 0.692). Men with suppressed or elevated TSH values did not score significantly lower than euthyroid men for any of nine domains of the RAND 36-Item Health Survey. Compared with euthyroid women, women with suppressed TSH scored significantly lower in the domains "physical functioning" (84 vs. 89, p = 0.013) and "general health" (67 vs. 72, p = 0.036). Women with markedly elevated TSH (> 10 mU/L) had a score in all HR-QOL domains that was similar to that of women with normal TSH values. There were no differences in the physical component score and the mental component score between any of the TSH groups. Physical component score and mental component score were mainly determined by smoking status, co-morbidity, and body mass index or waist circumference.
In this population-based study, HR-QOL scores of subjects with suppressed TSH values or markedly elevated TSH values were generally not significantly lower than those of subjects with normal or mildly elevated TSH values.
甲状腺疾病在西方社会很普遍，但许多患者在确诊时症状有限，尤其是甲状腺功能减退症患者。我们假设甲状腺激素功能测试异常程度越高的患者，其健康相关生活质量（HR-QOL）受损越严重。
这是一项对2009年12月至2010年8月参与生命线队列研究的荷兰成年人进行的横断面研究。在9491名西欧参与者（中位年龄45岁；3993名男性和5498名女性）中，目前或既往未使用过甲状腺药物，我们使用兰德36项健康调查对促甲状腺激素（TSH）值正常的受试者与甲状腺激素状态紊乱（血清TSH、游离甲状腺素和游离三碘甲状腺原氨酸）的受试者的HR-QOL进行了比较。还评估了可能的混杂因素（年龄、吸烟、合并症）对HR-QOL的影响。
114名（1.2%）受试者TSH值降低（TSH<0.5 mU/L），8334名（88.8%）受试者TSH值在正常范围内，973名参与者（10.3%）TSH值在4至10 mU/L之间，70名（0.7%）受试者TSH值>10 mU/L。男性的HR-QOL高于女性（70 - 92 vs. 65 - 89；p<0.001），但“总体健康”领域除外（72 vs. 72；p = 0.692）。TSH值降低或升高的男性在兰德36项健康调查的九个领域中的任何一个领域得分均未显著低于甲状腺功能正常的男性。与甲状腺功能正常的女性相比，TSH值降低的女性在“身体功能”（84 vs. 89，p = 0.013）和“总体健康”（67 vs. 72，p = 0.036）领域得分显著更低。TSH值显著升高（>10 mU/L）的女性在所有HR-QOL领域的得分与TSH值正常的女性相似。任何TSH组之间的身体成分得分和心理成分得分均无差异。身体成分得分和心理成分得分主要由吸烟状况、合并症以及体重指数或腰围决定。
在这项基于人群的研究中，TSH值降低或显著升高的受试者的HR-QOL得分通常并不显著低于TSH值正常或轻度升高的受试者。
