Department of Medical Endocrinology, PE2131, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
J Clin Endocrinol Metab. 2013 Sep;98(9):3802-10. doi: 10.1210/jc.2013-1610. Epub 2013 Jun 24.
Thyroid dysfunction may have detrimental effects on patient outcomes. Few studies have assessed this issue in patients with secondary hypothyroidism.
Our objective was to test the hypothesis that thyroid hormone status has an impact on cardiovascular risk factors in adult patients with hypopituitarism.
This was a retrospective observational study (1993-2012) at a tertiary referral university hospital.
All GH-deficient patients starting GH replacement (1993-2009) with measured free T4 (fT4) (n = 208). Baseline fT4 defined patients as TSH-sufficient and TSH-deficient (further divided into tertiles according to baseline fT4; first tertile had lowest fT4).
Anthropometric (body mass index [BMI], waist circumference, total fat (fat mass) and lean body mass [LBM]) and biochemical (lipids and fasting plasma glucose) data were collected at baseline and a median 4.1 years after commencement of GH.
At baseline, fT4 was negatively associated with BMI and waist circumference, but positively with high-density lipoprotein, independent of age, gender, and IGF-I (SD score). Only first-tertile TSH-deficient patients had higher BMI (P = .02), fat mass (P = .03), total cholesterol (P = .05), triglycerides (P < .01), and waist circumference (P = .01), and lower high-density lipoprotein cholesterol (P = .03) as compared with TSH-sufficient patients. At follow-up, IGF-I, LBM, and plasma glucose had increased in all subgroups (P < .01). The change in fT4 (ΔfT4) (follow-up - baseline) was negatively correlated to ΔBMI, ΔLBM, Δtotal cholesterol, and Δlow-density lipoprotein cholesterol (all P < .05, adjusted for ΔIGF-I and ΔGH and hydrocortisone dose). The negative correlation to Δtotal cholesterol and Δlow-density lipoprotein cholesterol persisted only in first-tertile TSH-deficient patients.
This single-center study over a 20-year period has strengthened the importance of improved awareness of thyroid status and optimal thyroid replacement of hypopituitary patients to reduce cardiovascular risks in hypopituitary patients.
甲状腺功能障碍可能对患者的预后产生不利影响。很少有研究评估继发性甲状腺功能减退症患者的这一问题。
我们的目的是检验甲状腺激素状态对垂体功能减退症成年患者心血管危险因素的影响这一假说。
这是一项在三级转诊大学医院进行的回顾性观察性研究（1993-2012 年）。
所有开始接受 GH 替代治疗的 GH 缺乏患者（1993-2009 年）均测量游离 T4（fT4）（n = 208）。基础 fT4 将患者定义为 TSH 充足和 TSH 缺乏（根据基础 fT4 进一步分为三分位；第一分位 fT4 最低）。
收集基线和 GH 开始后中位 4.1 年的人体测量学（体重指数[BMI]、腰围、总脂肪（体脂）和瘦体重[LBM]）和生化（血脂和空腹血糖）数据。
基线时，fT4 与 BMI 和腰围呈负相关，但与高密度脂蛋白呈正相关，与年龄、性别和 IGF-I（SD 评分）无关。只有第一分位 TSH 缺乏的患者 BMI（P =.02）、体脂（P =.03）、总胆固醇（P =.05）、甘油三酯（P <.01）和腰围（P =.01）更高，高密度脂蛋白胆固醇（P =.03）更低，与 TSH 充足的患者相比。在随访期间，所有亚组的 IGF-I、LBM 和血糖均增加（P <.01）。fT4 的变化（随访-基线）与 BMI、LBM、总胆固醇和 LDL 胆固醇的变化呈负相关（所有 P <.05，调整 IGF-I、GH 和 hydrocortisone 剂量后）。与总胆固醇和 LDL 胆固醇的负相关仅在第一分位 TSH 缺乏的患者中持续存在。
这项为期 20 年的单中心研究进一步强调了提高对垂体功能减退症患者甲状腺功能状态的认识和进行甲状腺激素替代治疗的重要性，以降低垂体功能减退症患者的心血管风险。
