1 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine , Los Angeles, California.
2 Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, VA Greater Los Angeles Healthcare System , Los Angeles, California.
Thyroid. 2018 Sep;28(9):1094-1100. doi: 10.1089/thy.2017.0362. Epub 2018 Jul 27.
Prior studies suggest that the relationship between hypothyroidism and mortality is dependent on underlying cardiovascular risk. Little is known about the association of hypothyroidism with hospitalization risk, and how these associations are modified by cardiovascular status.
This study examined the association of thyroid status, defined by serum thyrotropin (TSH), with hospitalization risk among patients who received care at a large university-based tertiary care center between 1990 and 2015. Thyroid status was categorized as hypothyroidism versus euthyroidism (TSH >4.7 vs. 0.3-4.7 mIU/L, respectively). The relationship between thyroid status and hospitalization risk stratified by cardiovascular status was examined using multivariable Cox models.
Among 52,856 patients who met eligibility criteria, 49,791 (94.2%) had euthyroidism and 3065 (5.8%) had hypothyroidism. In analyses stratified by congestive heart failure (CHF) status, compared to euthyroidism, hypothyroidism was associated with higher risk of hospitalization in those with CHF but slightly lower risk in those without CHF (adjusted hazard ratio [aHRs] = 1.86 [confidence interval (CI) 1.17-2.94] and HR = 0.95 [CI 0.92-0.99], respectively; p = 0.006). In sensitivity analyses accounting for death as a competing event, underlying coronary artery disease modified the hypothyroidism-hospitalization relationship, such that stronger associations were observed among those with versus without coronary artery disease. In competing risk analyses, hypothyroidism was associated with higher versus lower risk of hospitalization among those with versus without cerebrovascular disease, respectively.
Hypothyroidism is associated with higher hospitalization risk among patients with underlying cardiovascular disease. Future studies are needed to determine whether correction of thyroid status with replacement therapy ameliorates hospitalization risk in this population.
先前的研究表明，甲状腺功能减退症与死亡率之间的关系取决于潜在的心血管风险。关于甲状腺功能减退症与住院风险的关联以及这些关联如何受心血管状况的影响，人们知之甚少。
本研究检查了 1990 年至 2015 年期间在一家大型大学附属医院接受治疗的患者的甲状腺状态（通过血清促甲状腺激素（TSH）定义）与住院风险之间的关联。甲状腺状态分为甲状腺功能减退症与甲状腺功能正常（TSH>4.7 与 0.3-4.7 mIU/L 分别）。使用多变量 Cox 模型检查了甲状腺状态与心血管状态分层的住院风险之间的关系。
在符合入选标准的 52856 名患者中，49791 名（94.2%）为甲状腺功能正常，3065 名（5.8%）为甲状腺功能减退症。在心力衰竭（CHF）状态分层分析中，与甲状腺功能正常相比，CHF 患者的甲状腺功能减退症与更高的住院风险相关，但在无 CHF 患者中风险略低（校正后的危险比[aHR]分别为 1.86（95%置信区间[CI]1.17-2.94）和 0.95（95%CI 0.92-0.99）；p=0.006）。在考虑死亡为竞争事件的敏感性分析中，潜在的冠状动脉疾病改变了甲状腺功能减退症与住院之间的关系，使得在有与无冠状动脉疾病的患者中观察到更强的关联。在竞争风险分析中，与无脑血管疾病的患者相比，有脑血管疾病的患者甲状腺功能减退症与更高的住院风险相关，反之亦然。
甲状腺功能减退症与患有潜在心血管疾病的患者的住院风险较高相关。需要进一步的研究来确定在该人群中用替代疗法纠正甲状腺状态是否可以改善住院风险。
