Kalra Sanjay, Aggarwal Sameer, Khandelwal Deepak
Bharti Hospital and B.R.I.D.E., Karnal, India.
Apex Plus Super Speciality Hospital, Rohtak, India.
Int J Endocrinol. 2021 Mar 29;2021:9641846. doi: 10.1155/2021/9641846. eCollection 2021.
Thyroid dysfunction (TD) is common in metabolic disorders such as diabetes mellitus (DM), cardiovascular disease (CVD), obesity, dyslipidemia, hyperuricemia, kidney and liver dysfunctions, and polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SHypo) worsens glycemic control in patients with DM, and these patients, especially those with Type-1DM, have higher prevalence of TD. Both TD and DM increase CVD risk. Even minor alteration in thyroid hormone (TH) levels can alter cardiovascular function. While hyperthyroidism increases systolic blood pressure and leads to high-output heart failure, hypothyroidism increases diastolic blood pressure and leads to low-output heart failure. Chronic subclinical hyperthyroidism (SHyper) and SHypo both increase the risk of hypertension, coronary artery disease (CAD) events, CAD deaths, and total deaths. SHyper alters cardiac morphology and function. SHypo causes dyslipidemia and endothelial dysfunction and increases the risk for weight gain and obesity. Overweight and obese patients often have hyperleptinemia, which increases the secretion of thyroid stimulating hormone (TSH) and induces TD. Dyslipidemia associated with TD can increase serum uric acid levels. Hyperuricemia promotes inflammation and may increase the risk for dyslipidemia, atherosclerosis, and CVD. TD increases the risk for developing chronic kidney disease. In nephrotic syndrome, proteinuria is associated with urinary loss of TH leading to TD. Some correlation between TD and severity of liver disease is also seen. TD and PCOS have common risk factors and pathophysiological abnormalities. Hypothyroidism must be excluded before diagnosing PCOS. Current guidelines do not strongly recommend thyroid screening in the presence of all metabolic disorders. However, pragmatic thyrovigilance is required. Clinicians must stay alert to signs and symptoms of TD, maintain high clinical suspicion, and investigate thoroughly. Drug-induced TD should be considered when TH levels do not match clinical findings or when patients are on medications that can alter thyroid function.
甲状腺功能障碍（TD）在糖尿病（DM）、心血管疾病（CVD）、肥胖症、血脂异常、高尿酸血症、肝肾疾病以及多囊卵巢综合征（PCOS）等代谢紊乱疾病中很常见。亚临床甲状腺功能减退（SHypo）会使糖尿病患者的血糖控制恶化，而且这些患者，尤其是1型糖尿病患者，TD的患病率更高。TD和DM都会增加CVD风险。即使甲状腺激素（TH）水平有轻微变化也会改变心血管功能。甲状腺功能亢进会升高收缩压并导致高输出量心力衰竭，而甲状腺功能减退会升高舒张压并导致低输出量心力衰竭。慢性亚临床甲状腺功能亢进（SHyper）和SHypo都会增加高血压、冠状动脉疾病（CAD）事件、CAD死亡以及全因死亡的风险。SHyper会改变心脏形态和功能。SHypo会导致血脂异常和内皮功能障碍，并增加体重增加和肥胖的风险。超重和肥胖患者常伴有高瘦素血症，这会增加促甲状腺激素（TSH）的分泌并诱发TD。与TD相关的血脂异常会升高血清尿酸水平。高尿酸血症会促进炎症反应，并可能增加血脂异常、动脉粥样硬化和CVD的风险。TD会增加患慢性肾脏病的风险。在肾病综合征中，蛋白尿与TH的尿流失有关，从而导致TD。TD与肝病严重程度之间也存在一定相关性。TD和PCOS有共同的危险因素和病理生理异常。在诊断PCOS之前必须排除甲状腺功能减退。目前的指南并不强烈建议在所有代谢紊乱情况下都进行甲状腺筛查。然而，需要进行务实的甲状腺监测。临床医生必须对TD的体征和症状保持警惕，保持高度的临床怀疑，并进行全面调查。当TH水平与临床发现不相符或患者正在服用可能改变甲状腺功能的药物时，应考虑药物性TD。
