Department of Biochemistry, Post Graduate Institute of Medical Education & Research (PGIMER) & Dr. Ram Manohar Lohia (RML) Hospital, 1 Baba Kharak Singh Marg, New Delhi 110001, India.
Post Graduate Institute of Medical Education & Research (PGIMER) and Dr. Ram Manohar Lohia (RML) Hospital, 1 Baba Kharak Singh Marg, New Delhi 110001, India.
Eur J Intern Med. 2016 Nov;35:106-110. doi: 10.1016/j.ejim.2016.07.012. Epub 2016 Jul 26.
Hyperprolactinemia has been reported in 0-57% of primary hypothyroidism. Data on hyperprolactinemia in subclinical hypothyroidism (ScH) is scant and inconsistent. This study aimed to determine the prevalence and predictors of hyperprolactinemia in ScH.
Consecutive patients diagnosed to have normal thyroid function, ScH or overt primary hypothyroidism underwent serum prolactin, gonadotropins, testosterone and estradiol estimation. Patients with pregnancy, pituitary adenomas, secondary hypothyroidism, hyperthyroidism, comorbid states and drug-induced hyperprolactinemia were excluded.
From initially screened 4950 patients, hormonal data from 2848 individuals who fulfilled all criteria were analyzed. The occurrence of hyperprolactinemia (females:males) was highest in primary hypothyroidism (42.95%:39.53%) (n=192), followed by ScH (35.65%:31.61%) (n=770) and euthyroid individuals (2.32%:2.02%) (n=1886) (P<0.001). Hyperprolactinemia in ScH with TSH 5-7.5, 7.5-10 and >10mIU/L (females: males) was 25.56%:20.73%, 49.07%:50% and 61.43%:35.71% respectively (P<0.001). Significant positive correlation between TSH and prolactin was noted in ScH and primary hypothyroidism. In females, testosterone was lowest in patients with primary hypothyroidism. In males, serum estradiol was significantly higher, and testosterone significantly lower in men with ScH and primary hypothyroidism. Regression analysis revealed serum TSH followed by free T, to be best predictors of serum prolactin in both sexes.
Hyperprolactinemia is common in ScH, especially in those with TSH>7.5mIU/L. ROC analysis confirmed that TSH≥7.51mIU/L in females and ≥8.33mIU/L in males had a sensitivity of ≈50% with a very high specificity of >90% in detecting hyperprolactinemia. Prolactin screening may be warranted in ScH with TSH>7.5mIU/L, and may form an indication for treating ScH.
原发性甲状腺功能减退症患者中，催乳素升高的发生率为 0-57%。亚临床甲状腺功能减退症（ScH）患者催乳素升高的数据较少且不一致。本研究旨在确定 ScH 患者催乳素升高的患病率和预测因素。
连续诊断为甲状腺功能正常、ScH 或显性原发性甲状腺功能减退症的患者，检测血清催乳素、促性腺激素、睾酮和雌二醇。排除妊娠、垂体腺瘤、继发性甲状腺功能减退症、甲状腺功能亢进症、合并症和药物引起的高催乳素血症的患者。
从最初筛选的 4950 名患者中，分析了符合所有标准的 2848 名个体的激素数据。催乳素升高（女性：男性）发生率最高的是原发性甲状腺功能减退症（42.95%：39.53%）（n=192），其次是 ScH（35.65%：31.61%）（n=770）和甲状腺功能正常的个体（2.32%：2.02%）（n=1886）（P<0.001）。TSH 为 5-7.5、7.5-10 和>10mIU/L 的 ScH 患者催乳素升高的发生率（女性：男性）分别为 25.56%：20.73%、49.07%：50%和 61.43%：35.71%（P<0.001）。ScH 和原发性甲状腺功能减退症患者的 TSH 和催乳素之间存在显著的正相关。在女性中，原发性甲状腺功能减退症患者的睾酮最低。在男性中，ScH 和原发性甲状腺功能减退症患者的雌二醇显著升高，而睾酮显著降低。回归分析显示，血清 TSH 其次是游离 T，是男女血清催乳素的最佳预测指标。
高催乳素血症在 ScH 中很常见，尤其是 TSH>7.5mIU/L 的患者。ROC 分析证实，女性 TSH≥7.51mIU/L 和男性 TSH≥8.33mIU/L 的敏感性约为 50%，特异性>90%，可用于检测高催乳素血症。对于 TSH>7.5mIU/L 的 ScH 患者，可能需要进行催乳素筛查，并可能成为治疗 ScH 的指征。
