Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, Beijing, China.
Front Endocrinol (Lausanne). 2021 Jan 8;11:620407. doi: 10.3389/fendo.2020.620407. eCollection 2020.
Graves' disease (GD) and autoimmune thyroiditis (AIT) are two major causes of thyrotoxicosis that require correct diagnosis to plan appropriate treatment. The objectives of this study were to evaluate the usefulness of thyroid-related parameters for distinguishing GD from AIT and identify a novel index for differential diagnosis of thyrotoxicosis.
This retrospective study was performed using electronic medical records in Peking University People's Hospital (Beijing, China).
In total, 650 patients with GD and 155 patients with AIT from December 2015 to October 2019 were included in cohort 1. Furthermore, 133 patients with GD and 14 patients with AIT from December 2019 to August 2020 were included in cohort 2 for validation of the novel index identified in cohort 1. All patients were of Chinese ethnicity and were newly diagnosed with either GD or AIT. Thyroid-related clinical information was collected before intervention by reviewing the patients' electronic medical records. Receiver operating characteristic curve analysis was used to identify the optimal cutoff for distinguishing GD from AIT.
In cohort 1, thyroid-stimulating hormone (TSH) receptor antibody was identified as the best indicator for distinguishing GD from AIT. The area under the receiver operating characteristic curve was 0.99(95% confidence interval: 0.98-0.99, p<0.0001)and the optimal cutoff was 0.84 IU/l (98% sensitivity and 99% specificity). The free triiodothyronine (FT3)/TSH ratio (FT3/TSH) was the second -best for distinguishing GD from AIT, the area under the receiver operating characteristic curve of FT3/TSH was 0.86 (95% confidence interval: 0.84-0.88, p<0.0001); its optimal cutoff was 1.99 pmol/mIU (79% sensitivity and 80% specificity). Its effectiveness was confirmed in cohort 2 (81% sensitivity and 100% specificity).
The FT3/TSH ratio is a new useful index for differential diagnosis of thyrotoxicosis, especially when combined with TRAb.
格雷夫斯病（GD）和自身免疫性甲状腺炎（AIT）是导致甲状腺功能亢进的两个主要原因，需要正确诊断以制定适当的治疗方案。本研究的目的是评估甲状腺相关参数在鉴别 GD 和 AIT 中的作用，并确定一种新的诊断指数用于鉴别甲状腺功能亢进症。
这是一项在北京北京大学人民医院（中国北京）进行的回顾性电子病历研究。
共纳入 2015 年 12 月至 2019 年 10 月的 650 例 GD 患者和 155 例 AIT 患者为队列 1，纳入 2019 年 12 月至 2020 年 8 月的 133 例 GD 患者和 14 例 AIT 患者为队列 2，以验证队列 1 中确定的新指数。所有患者均为汉族，新诊断为 GD 或 AIT。通过回顾患者的电子病历收集干预前的甲状腺相关临床信息。采用受试者工作特征曲线分析确定鉴别 GD 和 AIT 的最佳截断值。
在队列 1 中，促甲状腺激素受体抗体被确定为鉴别 GD 和 AIT 的最佳指标。受试者工作特征曲线下面积为 0.99（95%置信区间：0.98-0.99，p<0.0001），最佳截断值为 0.84 IU/l（98%敏感性和 99%特异性）。游离三碘甲状腺原氨酸（FT3）/促甲状腺激素（TSH）比值（FT3/TSH）是鉴别 GD 和 AIT 的第二佳指标，其受试者工作特征曲线下面积为 0.86（95%置信区间：0.84-0.88，p<0.0001）；最佳截断值为 1.99 pmol/mIU（79%敏感性和 80%特异性）。在队列 2 中得到了验证（81%敏感性和 100%特异性）。
FT3/TSH 比值是一种新的鉴别甲状腺功能亢进症的有用指标，尤其是与 TRAb 联合使用时。
