肥胖患者的甲状腺疾病与自身免疫：叙述性综述。

Thyroid disease and autoimmunity in obese patients: a narrative review.

机构信息

Department of Clinical and Experimental Sciences, SSD Endocrinologia, University of Brescia, Azienda Socio-Sanitaria Territoriale (ASST) Spedali Civili di Brescia, Brescia, Italy.

Department of General Surgery 2, ASST Spedali Civili di Brescia, Italy.

出版信息

Endokrynol Pol. 2023;74(6). doi: 10.5603/ep.96255. Epub 2023 Nov 23.

DOI:10.5603/ep.96255

PMID:37994585

Abstract

INTRODUCTION

The high prevalence of obesity and thyroid diseases worldwide justifies di per se their simultaneous coexistence. In recent decades, there has been a parallel and significant rise in obesity and thyroid diseases in industrialised countries, although the underlying mechanisms are complex and not well known.

MATERIAL AND METHODS

The authors accomplished a comprehensive literature search of original articles concerning obesity and thyroid status. Original papers exploring the association between these two morbidities in children and adults were included.

RESULTS

A total of 79 articles were included in the present analysis. A total of 12% of obese children (mean age 10.9 ± 1.4 years) showed a thyroid disease, and they were younger than healthy obese children (10.9 ± 1.2 vs. 11.0 ± 0.4 years, p < 0.001). Isolated hyperthyrotropinaemia was the most frequent finding in children (10.1%). Autoimmune thyroid disease was more frequent in puberal age. Thyroid antibodies and subclinical hypothyroidism were more frequent in obese that in non-obese patients (7% vs. 3%, p < 0.001; 10% vs. 6%, p < 0.001). Among obese adults, 62.2% displayed a thyroid disease; those affected were younger (35.3 ± 6.8 vs. 41.0 ± 1.9 years, p < 0.001), heavier [body mass index (BMI): 39.4 ± 6.3 vs. 36.1 ± 2.3 kg/m², p < 0.001], and more frequently female (13% vs. 8%, p < 0.001). The most frequent disease was overt hypothyroidism (29.9%). BMI appears to be correlated with TSH levels in obese adults. Overt hypothyroidism was significantly more frequent in obese patients (7% vs. 3%, p < 0.005), but no difference was found in thyroid antibodies (15% vs. 14%, p = 0.178).

CONCLUSIONS

An undeniable relationship between obesity and thyroid impairments exists. Isolated hyperthyrotropinaemia is frequently seen in obese children, often followed by spontaneous resolution. Subclinical hypothyroidism should never be treated in children or adults with the aim of reducing body weight.

摘要

简介

肥胖和甲状腺疾病在全球的高患病率证明了它们的同时存在。近几十年来，工业化国家的肥胖和甲状腺疾病呈平行且显著上升，尽管潜在机制复杂且尚未完全了解。

材料与方法

作者对肥胖和甲状腺状态的原始文章进行了全面的文献检索。纳入了探讨这两种疾病在儿童和成人中相关性的原始论文。

结果

本分析共纳入 79 篇文章。肥胖儿童（平均年龄 10.9 ± 1.4 岁）中共有 12%存在甲状腺疾病，且他们比健康肥胖儿童更年轻（10.9 ± 1.2 岁比 11.0 ± 0.4 岁，p < 0.001）。单纯性促甲状腺激素增高是儿童中最常见的表现（10.1%）。青春期时更常见自身免疫性甲状腺疾病。甲状腺抗体和亚临床甲状腺功能减退症在肥胖患者中比非肥胖患者更常见（7%比 3%，p < 0.001；10%比 6%，p < 0.001）。肥胖成年人中，62.2%存在甲状腺疾病；患病者更年轻（35.3 ± 6.8 岁比 41.0 ± 1.9 岁，p < 0.001），更重[体重指数（BMI）：39.4 ± 6.3 千克/平方米比 36.1 ± 2.3 千克/平方米，p < 0.001]，且更常为女性（13%比 8%，p < 0.001）。最常见的疾病是显性甲状腺功能减退症（29.9%）。BMI 似乎与肥胖成年人的 TSH 水平相关。肥胖患者中显性甲状腺功能减退症明显更常见（7%比 3%，p < 0.005），但甲状腺抗体无差异（15%比 14%，p = 0.178）。