Department of Endocrinology and Metabolism, Bezmialem University, Vatan Caddesi, 34093, Istanbul, Turkey,
J Endocrinol Invest. 2014 Jul;37(7):639-44. doi: 10.1007/s40618-014-0085-6. Epub 2014 May 21.
Gastrointestinal tract is one of the most affected systems in hypothyroidism. Despite decreased esophageal emptying, prolonged esophageal and gastric transit time have been indicated in previous reports, the mechanism of thyroid hormones activity and antibodies on the esophagus motility is not yet fully understood. This study was conducted to evaluate the esophagus motility by manometry in hypothyroid patients.
The study enrolled with 28 overt, newly diagnosed hypothyroid patients and 29 age- and sex-matched healthy controls. Twenty-one females and 7 males with overt hypothyroidism and 22 females and 7 males with healthy control subjects were recruited to study. Esophageal manometry was performed using MMS (Medical Measurement Systems bv. The Netherlands) Solar GI-Air-Charged Intelligent Gastrointestinal Conventional Manometry.
The lower esophageal sphincter pressure (LESP) was 19.5 ± 6.5 mmHg in hypothyroid patients and 17.48 ± 4.65 mmHg in controls, and there was no significant difference (p = 0.18). Percentage of relaxation was 61.5 and 80.9 %, and it was significantly lower in hypothyroid patients than controls (p < 0.001). Additionally, duration of relaxation was found 3.85 ± 2.3 and 5.5 ± 2.28 s in patients and controls, respectively (p = 0.009). In patient group, LESP was positively correlated with fT3 (p = 0.033), and the duration of the contraction was negatively correlated with fT4 (p = 0.044).
In this study, we observed that hypothyroid state can affect esophagus motility via shortened duration of relaxation and reduced percentage of relaxation even if in patients without any gastrointestinal symptoms. Further studies are needed to clarify the effect of thyroid hormones on esophagus motility.
甲状腺功能减退症可影响多个系统，胃肠道首当其冲。尽管已有研究报道甲状腺功能减退症患者存在食管排空延迟，但食管和胃转运时间延长的确切机制尚未完全阐明。本研究旨在通过食管测压评估甲状腺功能减退症患者的食管动力。
本研究纳入了 28 例新诊断的甲状腺功能减退症患者和 29 名年龄和性别匹配的健康对照者。其中 21 例女性和 7 例男性为甲状腺功能减退症患者，22 例女性和 7 例男性为健康对照者。采用 MMS（荷兰 Medical Measurement Systems 公司）Solar GI-Air-Charged 智能胃肠常规测压系统进行食管测压。
甲状腺功能减退症患者的食管下括约肌压力（LESP）为 19.5±6.5mmHg，健康对照组为 17.48±4.65mmHg，两组间差异无统计学意义（p=0.18）。甲状腺功能减退症患者的食管下段松弛百分比为 61.5%，显著低于健康对照组的 80.9%（p<0.001）。此外，甲状腺功能减退症患者的食管下段松弛持续时间为 3.85±2.3s，健康对照组为 5.5±2.28s，两组间差异有统计学意义（p=0.009）。在患者组中，LESP 与游离三碘甲状腺原氨酸（fT3）呈正相关（p=0.033），收缩持续时间与游离甲状腺素（fT4）呈负相关（p=0.044）。
本研究发现甲状腺功能减退症患者即使无胃肠道症状，也存在食管动力障碍，表现为食管下段松弛持续时间缩短和松弛百分比降低。需要进一步研究以阐明甲状腺激素对食管动力的影响。
