Thyroid Unit, Department of Endocrinology and Metabolism, Unidad Asistencial Dr. César Milstein/PAMI-INSSJP, La Rioja 951, (1221), Buenos Aires, Argentina.
Depto. de Bioquímica Clínica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.
J Endocrinol Invest. 2019 Jun;42(6):667-671. doi: 10.1007/s40618-018-0967-0. Epub 2018 Oct 26.
Non-thyroidal illness (NTI) is frequent in hospitalized patients. Its recovery is characterized by a raise in TSH levels. However, the clinical significance of high TSH levels at admission in hospitalized elderly patients with NTI remains uncertain.
To explore the relevance of baseline TSH evaluation in hospitalized elderly patients with NTI.
We examined the participants with NTI (n = 123) from our previous study (Sforza, 2017). NTI was defined as: low T3 (< 80 ng/dL) and normal or low total T4 in the presence of TSH values between 0.1 and 6.0 mU/L. Thyroid function tests were performed on day 1 and day 8 of the hospital stay. Positive TSH changes (+ ΔTSH) were considered when the day-8 TSH value increased more than the reference change value for TSH (+ 78%). Multiple logistic regression was used to evaluate the independent association of baseline TSH, sex, clinical comorbidities (by ACE-27) and medications with + ΔTSH.
Out of 123 patients (77 ± 8 years, 52% female), 34 showed a + ΔTSH. These patients had a lower TSH at admission (p < 0.001) and intra-hospital mortality (p = 0.003) than the others. In multiple logistic regression, TSH > 2.11 mU/L at baseline was associated with reduced odds to show + ΔTSH [odds ratio (95 CI) 0.29 (0.11-0.75); p = 0.011] in a model adjusted by age, sex and ACE-27.
Inappropriately higher TSH levels at admission in hospitalized elderly patients were associated with a reduced ability to raise their TSH levels later on. The present results confront the idea that TSH levels at admission are irrelevant in this clinical context.
非甲状腺疾病（NTI）在住院患者中很常见。其恢复的特征是 TSH 水平升高。然而，住院老年 NTI 患者入院时 TSH 水平升高的临床意义仍不确定。
探讨住院老年 NTI 患者基线 TSH 评估的相关性。
我们检查了我们之前的研究（Sforza，2017 年）中的 NTI 患者（n=123）。NTI 的定义为：在 TSH 值为 0.1 至 6.0 mU/L 之间时，低 T3（<80ng/dL）和正常或低总 T4。在住院的第 1 天和第 8 天进行甲状腺功能检查。当第 8 天的 TSH 值增加超过 TSH 的参考变化值（+78%）时，认为 TSH 发生了阳性变化（+ΔTSH）。使用多因素逻辑回归评估基线 TSH、性别、临床合并症（通过 ACE-27）和药物与+ΔTSH 的独立相关性。
在 123 名患者（77±8 岁，52%为女性）中，有 34 名患者出现了+ΔTSH。这些患者入院时 TSH 较低（p<0.001），住院期间死亡率较高（p=0.003）。在多因素逻辑回归中，基线 TSH>2.11mU/L 与出现+ΔTSH 的几率降低相关[优势比（95%CI）0.29（0.11-0.75）；p=0.011]，该模型通过年龄、性别和 ACE-27 进行了调整。
住院老年 NTI 患者入院时 TSH 水平过高与随后升高 TSH 水平的能力降低有关。本研究结果与 TSH 水平在入院时在该临床环境中无关的观点相悖。
