Carlé Allan, Knudsen Nils, Jørgensen Torben, Thuesen Bettina, Karmisholt Jesper, Linding Andersen Stine, Bülow Pedersen Inge
Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Institute, Aalborg University, Aalborg, Denmark.
Eur Thyroid J. 2019 Apr;8(2):70-78. doi: 10.1159/000494836. Epub 2018 Dec 14.
To investigate the association between reproductive history and later development of various nosological subtypes of overt hyperthyroidism.
From the Danish population, we included incident hyperthyroid women, and for each case we recruited 4 euthyroid age-sex-region-matched controls from the same sub-population. Hyperthyroid cases/controls were: Graves' disease (GD, = 232/928), multinodular toxic goitre (MNTG, = 91/364), solitary toxic adenoma (STA, = 21/84). Patients diagnosed with hyperthyroidism within 1 year after delivery including post-partum GD were excluded. In multivariate conditional regression models (reference: no reproductive events), we analysed the association between development of GD/MNTG/STA and reproductive factors such as age at menarche/menopause, reproductive span, number of pregnancies/childbirths/abortions, investigations for infertility, and years on oral contraceptives. We adjusted for possible confounders such as alcohol intake, smoking, co-morbidity, and education. Age was studied as a potential effect measure modifier.
GD patients diagnosed before the age of 40 years had given births more often than control subjects (OR [95% CI] for 1/2/3+ births [ref.: nulliparous] were 1.57 [0.80-3.11]/2.06 [1.001-4.22]/3.07 [1.50-6.26]), and they had induced abortions performed more often (OR for 1/2+ induced abortions [ref.: no: events] were 0.99 [0.54-1.84]/2.24 [1.12-4.45]). No associations were observed between any reproductive factor and the development of MNTG or STA.
Childbirths and induced abortions may be followed by development of Graves' hyperthyroidism after the post-partum period. This was not the case for the non-autoimmune subtypes of hyperthyroidism.
研究生殖史与显性甲状腺功能亢进症各病种亚型后期发病之间的关联。
从丹麦人群中纳入新诊断的甲状腺功能亢进症女性，对于每例患者，我们从同一亚人群中招募4名年龄、性别、地区匹配的甲状腺功能正常的对照。甲状腺功能亢进症病例/对照分别为：格雷夫斯病（GD，232/928）、多结节毒性甲状腺肿（MNTG，91/364）、孤立性毒性腺瘤（STA，21/84）。排除产后1年内诊断为甲状腺功能亢进症的患者，包括产后GD。在多变量条件回归模型中（参照：无生殖事件），我们分析了GD/MNTG/STA发病与初潮/绝经年龄、生殖期、妊娠/分娩/流产次数、不孕症检查以及口服避孕药年限等生殖因素之间的关联。我们对可能的混杂因素进行了校正，如酒精摄入、吸烟、合并症和教育程度。将年龄作为潜在的效应测量修饰因素进行研究。
40岁之前诊断的GD患者分娩次数多于对照（1/2/3次及以上分娩的OR[95%CI][参照：未生育]分别为1.57[0.80 - 3.11]/2.06[1.001 - 4.22]/3.07[1.50 - 6.26]），且她们进行人工流产的次数更多（1次/2次及以上人工流产的OR[参照：无此类事件]分别为0.99[0.54 - 1.84]/2.24[1.12 - 4.45]）。未观察到任何生殖因素与MNTG或STA发病之间存在关联。
分娩和人工流产后，产后可能会发生格雷夫斯甲状腺功能亢进症。非自身免疫性甲状腺功能亢进症亚型并非如此。
