Ryödi Essi, Salmi Jorma, Jaatinen Pia, Huhtala Heini, Saaristo Rauni, Välimäki Matti, Auvinen Anssi, Metso Saara
Heart Center Co., Tampere University Hospital, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland.
Clin Endocrinol (Oxf). 2014 May;80(5):743-50. doi: 10.1111/cen.12359. Epub 2013 Dec 5.
Previous studies suggest that patients with hyperthyroidism remain at an increased risk of cardiovascular morbidity even after restoring euthyroidism. The mechanisms of the increased risk and its dependency on the different treatment modalities of hyperthyroidism remain unclear. The aim of this long-term follow-up study was to compare the rate of hospitalizations for cardiovascular causes and the mortality in hyperthyroid patients treated surgically with an age- and gender-matched reference population.
A population-based cohort study was conducted among 4334 hyperthyroid patients (median age 46 years) treated with thyroidectomy in 1986-2007 in Finland and among 12,991 reference subjects. Firstly, the hospitalizations due to cardiovascular diseases (CVD) were analysed until thyroidectomy. Secondly, the hazard ratios for any new hospitalization due to CVDs after the thyroidectomy were calculated in Cox regression analysis adjusted with the prevalent CVDs at the time of thyroidectomy.
The risk of hospitalization due to all CVDs started to increase already 5 years before the thyroidectomy, and by the time of the operation, it was 50% higher in the hyperthyroid patients compared to the controls (P < 0·001). After the thyroidectomy, the hospitalizations due to all CVDs (HR 1·15), hypertension (HR 1·23), heart failure (HR 1·17) and valvular diseases or cardiomyopathies (HR 1·55) remained more frequent among the patients than among the controls for 20 years after thyroidectomy. The increased morbidity was not clearly related to the aetiology of hyperthyroidism. Despite the increased CVD morbidity among the patients, there was no difference in cardiovascular mortality.
The present study shows that hyperthyroidism increases the risk of hospitalization due to CVDs and the risk is sustained up to two decades after effective surgical treatment. However, there was no excess CVD mortality in the middle-aged patient cohort studied.
既往研究表明，即使甲状腺功能恢复正常，甲状腺功能亢进症患者心血管疾病发病风险仍会增加。风险增加的机制及其与甲状腺功能亢进症不同治疗方式的相关性仍不清楚。这项长期随访研究的目的是比较接受手术治疗的甲状腺功能亢进症患者与年龄和性别匹配的参照人群的心血管疾病住院率和死亡率。
在芬兰，对1986年至2007年接受甲状腺切除术的4334例甲状腺功能亢进症患者（中位年龄46岁）以及12991例参照对象进行了一项基于人群的队列研究。首先，分析甲状腺切除术之前因心血管疾病（CVD）导致的住院情况。其次，在对甲状腺切除术时存在的CVD进行校正的Cox回归分析中，计算甲状腺切除术后因CVD导致的任何新住院的风险比。
在甲状腺切除术之前5年，所有CVD导致的住院风险就已开始增加，到手术时，甲状腺功能亢进症患者的该风险比对照组高50%（P<0.001）。甲状腺切除术后20年，患者中因所有CVD（风险比1.15）、高血压（风险比1.23）、心力衰竭（风险比1.17）以及瓣膜疾病或心肌病（风险比1.55）导致的住院仍比对照组更频繁。发病率增加与甲状腺功能亢进症的病因没有明显关联。尽管患者中CVD发病率增加，但心血管死亡率没有差异。
本研究表明，甲状腺功能亢进症会增加因CVD导致的住院风险，且该风险在有效手术治疗后长达二十年仍持续存在。然而，在所研究的中年患者队列中，没有额外的CVD死亡率。
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