Nair Sashi Niranjan, Kumar Harish, Raveendran Manoj, Menon V Usha
Department of Endocrinology, Amrita School of Medicine, Amrita University, Kochi, Kerala, India.
Department of Endocrinology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India.
Indian J Endocrinol Metab. 2018 Mar-Apr;22(2):217-222. doi: 10.4103/ijem.IJEM_298_17.
The benefits of treating subclinical hypothyroidism are currently under debate, prevention of adverse cardiac events purporting to be one of the main benefits. The effect of subclinical hypothyroidism on the cardiovascular health of the Indian sub-population is largely unknown. This study was designed to examine these effects and to help guide treatment of this disorder.
A cross-sectional adult population survey was carried out in urban coastal area of central Kerala. 986 volunteers underwent complete biochemical and physical examinations, 110 were found to have subclinical hypothyroidism (8.9%). The ten-year risk of an adverse cardiac event, was calculated using the Framingham score algorithm. Eligible subclinical hypothyroid subjects ( = 110) and a randomly selected, age and gender matched control group ( = 220) were compared.
This population was found to have high baseline levels of diabetes 19.5%, hypercholesterolemia 57.2% and systolic hypertension 24.6%. No association was found between subclinical hypothyroid status or rising TSH and Framingham 10-year risk. While no difference between groups was noted with respect to lipid profile, a rising TSH was found to be significantly correlated with mild worsening of the lipid profile. A significant positive correlation was found between skinfold thickness and TSH.
Subclinical hypothyroidism is not a contributing factor to elevated Framingham risk in this population, and while a mild effect was observed on the lipid profile, its effect is unlikely to be clinically relevant. We hypothesize that in this population a genetic component may be responsible for the uniquely high rates of metabolic syndrome and other endocrine diseases.
目前，亚临床甲状腺功能减退症的治疗益处存在争议，预防不良心脏事件据称是主要益处之一。亚临床甲状腺功能减退症对印度亚人群心血管健康的影响在很大程度上尚不清楚。本研究旨在探讨这些影响，并为该疾病的治疗提供指导。
在喀拉拉邦中部的城市沿海地区进行了一项横断面成年人口调查。986名志愿者接受了全面的生化和体格检查，发现110人患有亚临床甲状腺功能减退症（8.9%）。使用弗雷明汉评分算法计算不良心脏事件的十年风险。比较了符合条件的亚临床甲状腺功能减退症患者（n = 110）和随机选择的年龄和性别匹配的对照组（n = 220）。
该人群的糖尿病基线水平较高（19.5%）、高胆固醇血症（57.2%）和收缩期高血压（24.6%）。未发现亚临床甲状腺功能减退状态或促甲状腺激素升高与弗雷明汉十年风险之间存在关联。虽然两组在血脂谱方面未发现差异，但促甲状腺激素升高与血脂谱轻度恶化显著相关。发现皮褶厚度与促甲状腺激素之间存在显著正相关。
在该人群中，亚临床甲状腺功能减退症不是弗雷明汉风险升高的促成因素，虽然观察到对血脂谱有轻微影响，但其影响在临床上可能无关紧要。我们推测，在该人群中，遗传因素可能是代谢综合征和其他内分泌疾病独特高发病率的原因。
