Institute of EndocrinologyRabin Medical Center-Beilinson Hospital, Petah Tikva, Israel
Sackler School of MedicineTel Aviv University, Tel Aviv, Israel.
Eur J Endocrinol. 2017 Jan;176(1):57-66. doi: 10.1530/EJE-16-0708. Epub 2016 Oct 19.
Numerous studies investigated the link between hypothyroidism and mortality, but a definite conclusion is hard to reach as these were limited by a number of factors, including age of participants, comorbidities and single measurement of thyroid function.
To evaluate the association between TSH and fT4 levels and mortality in patients with levothyroxine-treated hypothyroidism.
Observational data of hospitalized patients (2011-2014). TSH and fT4 levels obtained between at least 30 days after discharge and until death or end of follow-up were collected. Median TSH and fT4 levels were stratified into categories.
In total, 611 patients with treated hypothyroidism, aged 60-80 years (72% females, mean age 71 ± 6 years) were included in the study.
All-cause mortality up to 66 months after discharge, by TSH and fT4 categories.
During follow-up, the average numbers of TSH and fT4 measurements were 5.5 ± 3.8 and 2.5 ± 4.2 per patient respectively. Mortality rates were 28%, 29% and 54% with median TSH of 0.5-2.5, 2.5-5.0 and 5.0-10.0 IU/L respectively. Adjusted hazard ratios for mortality with median TSH between 5.0 and 10.0 IU/L were 2.3 (95% CI: 1.6-3.4) and 2.2 (95% CI: 1.6-3.2) compared with patients with TSH between 0.5-2.5 IU/L and 2.5-5 IU/L respectively. There was no difference in mortality between patients with median fT4 10-15 or 15-20 pmol/L.
In treated hypothyroid adult patients and serial measurements of thyroid function tests, median TSH levels of 5-10 IU/L are associated with increased mortality with no effect of fT4 levels. Treatment should aim at achieving euthyroidism to improve survival.
许多研究调查了甲状腺功能减退症与死亡率之间的联系，但由于多种因素的限制，如参与者的年龄、合并症和甲状腺功能的单次测量，难以得出明确的结论。
评估左旋甲状腺素治疗的甲状腺功能减退症患者中 TSH 和游离甲状腺素（fT4）水平与死亡率之间的关系。
观察性住院患者数据（2011-2014 年）。收集至少在出院后 30 天至死亡或随访结束之间获得的 TSH 和 fT4 水平。将中位 TSH 和 fT4 水平分为几类。
共纳入 611 例年龄在 60-80 岁（72%为女性，平均年龄 71±6 岁）的接受治疗的甲状腺功能减退症患者。
出院后 66 个月内的全因死亡率，按 TSH 和 fT4 类别划分。
在随访期间，每位患者的 TSH 和 fT4 测量次数平均分别为 5.5±3.8 次和 2.5±4.2 次。中位 TSH 分别为 0.5-2.5、2.5-5.0 和 5.0-10.0IU/L 时，死亡率分别为 28%、29%和 54%。与 TSH 在 0.5-2.5IU/L 和 2.5-5IU/L 之间的患者相比，TSH 中位数在 5.0-10.0IU/L 之间的患者死亡的调整危险比分别为 2.3（95%CI：1.6-3.4）和 2.2（95%CI：1.6-3.2）。中位 fT4 为 10-15 或 15-20pmol/L 的患者死亡率无差异。
在接受治疗的甲状腺功能减退症成年患者和甲状腺功能检测的连续测量中，TSH 中位数为 5-10IU/L 与死亡率增加相关，而游离甲状腺素水平无影响。治疗应旨在实现甲状腺功能正常以提高生存率。
