Bashkin Amir, Abu Ali Jalaa, Shehadeh Mona, Even Lea, Ronen Ohad
Endocrinology Unit, Galilee Medical Center, Nahariya, Israel.
Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Endocrine. 2021 May;72(2):445-451. doi: 10.1007/s12020-020-02463-6. Epub 2020 Sep 2.
There is scarce data about the interpretation of high thyroid hormone levels in hospitalized patients. We wished to investigate the significance of high thyroxine (T4) in hospitalized patients with low TSH.
We conducted a retrospective study of data from patients in nonsurgical departments. Three groups of random patients with low TSH were defined and compared: 123 patients with only high FT4 levels (T4 group), 82 with high FT3 levels with or without high FT4 level (T3 group), and 119 with low FT3 and FT4 level in the lower half of the norm and below (NTIS group).
The primary cause of admission in the T4 and NTIS groups was infectious disease, 20.3% and 40.3%, respectively; while in the T3 group it was cardiovascular disease (31.7%). The T4 group but not T3 group had epidemiological and clinical characteristics similar to the NTIS group. The T4 group had a significant correlation between increased CRP levels and decreased FT3 (r = 0.366, p < 0.001) similar to the NTIS group. The T3 group had a borderline correlation between increased FT3 and FT4 levels (r = 0.208, p = 0.061) but the T4 group did not.
The combination of low TSH and high FT4 levels in hospitalized patient is usually caused by nonthyroidal illness combined with drug effects. This thyroid function disturbance is common in hospitalized patients and if the FT3 level is below the middle of the norm, treatment is probably unnecessary.
关于住院患者甲状腺激素水平升高的解读，现有数据稀缺。我们希望研究促甲状腺激素（TSH）水平低的住院患者中高甲状腺素（T4）的意义。
我们对非外科科室患者的数据进行了回顾性研究。定义并比较了三组随机的TSH水平低的患者：123例仅FT4水平高的患者（T4组），82例FT3水平高（无论FT4水平是否高）的患者（T3组），以及119例FT3和FT4水平处于正常范围下半部分及以下的患者（非甲状腺疾病综合征组）。
T4组和非甲状腺疾病综合征组的主要入院原因是传染病，分别为20.3%和40.3%；而T3组的主要入院原因是心血管疾病（31.7%）。T4组而非T3组具有与非甲状腺疾病综合征组相似的流行病学和临床特征。与非甲状腺疾病综合征组相似，T4组中CRP水平升高与FT3降低之间存在显著相关性（r = 0.366，p < 0.001）。T3组中FT3和FT4水平升高之间存在临界相关性（r = 0.208，p = 0.061），但T4组不存在。
住院患者中TSH低且FT4水平高通常是由非甲状腺疾病合并药物作用引起的。这种甲状腺功能紊乱在住院患者中很常见，如果FT3水平低于正常范围的中间值，可能无需治疗。
