Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Biomedicine and Health Sciences, The Catholic University of Korea, Seoul, Republic of Korea.
Sci Rep. 2021 Oct 13;11(1):20305. doi: 10.1038/s41598-021-98954-1.
Allopurinol is the first-line agent for patients with gout, including those with moderate-to-severe chronic kidney disease. However, increased thyroid-stimulating hormone (TSH) levels are observed in patients with long-term allopurinol treatment. This large-scale, nested case-control, retrospective observational study analysed the association between allopurinol use and increased TSH levels. A common data model based on an electronic medical record database of 19,200,973 patients from seven hospitals between January 1997 and September 2020 was used. Individuals aged > 19 years in South Korea with at least one record of a blood TSH test were included. Data of 59,307 cases with TSH levels > 4.5 mIU/L and 236,508 controls matched for sex, age (± 5), and cohort registration date (± 30 days) were analysed. An association between the risk of increased TSH and allopurinol use in participants from five hospitals was observed. A meta-analysis (I = 0) showed that the OR was 1.51 (95% confidence interval: 1.32-1.72) in both the fixed and random effects models. The allopurinol intake group demonstrated that increased TSH did not significantly affect free thyroxine and thyroxine levels. After the index date, some diseases were likely to occur in patients with subclinical hypothyroidism and hypothyroidism. Allopurinol administration may induce subclinical hypothyroidism.
别嘌醇是痛风患者的一线药物，包括中重度慢性肾脏病患者。然而，长期使用别嘌醇治疗的患者甲状腺刺激激素（TSH）水平升高。这项大规模、巢式病例对照、回顾性观察研究分析了别嘌醇使用与 TSH 水平升高之间的关系。该研究使用了一个基于电子病历数据库的通用数据模型，该数据库包含了来自 7 家医院的 19200973 名患者的信息，数据时间范围为 1997 年 1 月至 2020 年 9 月。该研究纳入了年龄大于 19 岁、至少有一次 TSH 检测记录的韩国患者。对 59307 例 TSH 水平>4.5 mIU/L 的病例和 236508 例性别、年龄（±5）和队列登记日期（±30 天）匹配的对照组数据进行了分析。在来自 5 家医院的参与者中观察到 TSH 升高与别嘌醇使用之间存在关联。荟萃分析（I=0）显示，在固定和随机效应模型中，OR 分别为 1.51（95%置信区间：1.32-1.72）。别嘌醇摄入组表明，TSH 升高不会显著影响游离甲状腺素和甲状腺素水平。在索引日期后，亚临床甲状腺功能减退症和甲状腺功能减退症患者可能会发生某些疾病。别嘌醇的使用可能会导致亚临床甲状腺功能减退症。
