Klein Hesselink Esther N, Lefrandt Joop D, Schuurmans Edwin P, Burgerhof Johannes G M, Groen Bart, Gansevoort Ron T, van der Horst-Schrivers Anouk N A, Dullaart Robin P F, Van Gelder Isabelle C, Brouwers Adrienne H, Rienstra Michiel, Links Thera P
University of Groningen, University Medical Center Groningen, Departments of Vascular Medicine (E.N.K.H., J.D.L., E.P.S.), Endocrinology (E.N.K.H., B.G., A.N.A.v.d.H.-S., R.P.F.D., T.P.L.), Epidemiology (J.G.M.B.), Nephrology (R.T.G.), Cardiology (I.C.V.G., M.R.), and Nuclear Medicine and Molecular Imaging (A.H.B.), 9700 RB Groningen, The Netherlands.
J Clin Endocrinol Metab. 2015 Dec;100(12):4563-9. doi: 10.1210/jc.2015-2782. Epub 2015 Oct 19.
Patients with differentiated thyroid carcinoma (DTC) have a favorable prognosis after treatment with thyroidectomy, radioiodine, and TSH suppression. However, treatment is associated with long-term cardiovascular toxicity. The aim of this study was to evaluate whether there is an increased risk of atrial fibrillation (AF) in DTC patients and whether AF occurrence is related to DTC treatment.
Incident AF was compared between 518 DTC patients and 1563 matched controls. A cumulative incidence curve was plotted, and competing risk regression analyses with adjustment for all-cause mortality were performed. Within the DTC cohort, associations between time-varying DTC treatment variables and incident AF were analyzed.
For both cohorts, the mean age was 48.6 years (75% of subjects were women). The AF incidence rate was 6.2/1000 person-years for DTC patients and 2.7/1000 person-years for controls. DTC patients had a 2.25-fold (95% confidence interval [CI], 1.40-3.63) and 2.47-fold (95% CI, 1.55-3.95) increased AF risk in crude and fully adjusted analyses, respectively. Within the DTC cohort, the TSH level (which was suppressed in 85.7% of patients) was not associated with AF, whereas a higher cumulative radioiodine dose slightly increased AF risk: subdistribution hazard ratio, 1.04 (95% CI, 1.01-1.08) per 50 mCi (1.85 GBq) increase, after adjustment.
Patients with DTC have an increased AF risk, independent from established AF risk factors. We could not demonstrate a relation between TSH and AF, whereas a higher cumulative radioiodine dose was associated with a slightly increased AF risk. Electrocardiogram screening for AF may be warranted during follow-up of DTC patients to allow early diagnosis and treatment of AF and to prevent its complications.
分化型甲状腺癌（DTC）患者在接受甲状腺切除术、放射性碘治疗和促甲状腺激素（TSH）抑制治疗后预后良好。然而，该治疗与长期心血管毒性相关。本研究的目的是评估DTC患者发生心房颤动（AF）的风险是否增加，以及AF的发生是否与DTC治疗有关。
比较了518例DTC患者和1563例匹配对照者的新发AF情况。绘制了累积发病率曲线，并进行了校正全因死亡率的竞争风险回归分析。在DTC队列中，分析了随时间变化的DTC治疗变量与新发AF之间的关联。
两个队列的平均年龄均为48.6岁（75%的受试者为女性）。DTC患者的AF发病率为6.2/1000人年，对照者为2.7/1000人年。在粗分析和完全校正分析中，DTC患者发生AF的风险分别增加了2.25倍（95%置信区间[CI]，1.40 - 3.63）和2.47倍（95%CI，1.55 - 3.95）。在DTC队列中，TSH水平（85.7%的患者处于抑制状态）与AF无关，而累积放射性碘剂量越高，AF风险略有增加：校正后，每增加50毫居里（1.85吉贝可），亚分布风险比为1.04（95%CI，1.01 - 1.08）。
DTC患者发生AF的风险增加，独立于既定的AF危险因素。我们未能证明TSH与AF之间存在关联，而累积放射性碘剂量越高，AF风险略有增加。在DTC患者的随访期间，可能有必要进行AF的心电图筛查，以便早期诊断和治疗AF并预防其并发症。
