Deguchi-Horiuchi Hanna, Ito Mitsuru, Takahashi Sawako, Kousaka Kazuyoshi, Hisakado Mako, Fukata Shuji, Kudo Takumi, Nishihara Eijun, Nishikawa Mitsushige, Miyauchi Akira, Akamizu Takashi
Center for Excellence in Thyroid Care, Kuma Hospital, Kobe 650-0011, Japan.
Endocr J. 2024 Apr 30;71(4):373-381. doi: 10.1507/endocrj.EJ23-0497. Epub 2024 Jan 31.
Subclinical hyperthyroidism (SHyper) is defined as normal levels of free thyroxine (fT4) and free triiodothyronine (fT3) with suppressed levels of TSH. Previous studies have reported the individual pathophysiology of endogenous SHyper patients and athyreotic patients receiving TSH suppression therapy with levothyroxine; however, apparently no studies have compared the two conditions. Five-hundred-forty untreated endogenous SHyper patients and 1,024 patients receiving TSH suppression therapy who underwent total thyroidectomy for papillary thyroid carcinoma were sampled. Thyroid hormone profiles and peripheral indices related to thyrotoxicosis were investigated in endogenous SHyper patients, athyreotic patients receiving TSH suppression therapy, and healthy participants. Endogenous SHyper patients showed significantly higher thyroid hormone levels (fT4 [p < 0.001] and fT3 [p < 0.001]), and peripheral indices showed a significant tendency towards thyrotoxicosis (strong TSH suppression: alkaline phosphatase [ALP, p < 0.001], creatinine [Cre, p < 0.001], pulse rate [p < 0.05]; and mild TSH suppression: Cre [p < 0.05]) than healthy participants. In contrast, athyreotic patients receiving TSH suppression therapy showed a significant tendency towards thyrotoxicosis than healthy participants only when TSH was strongly suppressed (fT3 [p < 0.001] and Cre [p < 0.001]). Endogenous SHyper patients showed significantly higher fT3 levels (p < 0.001) than athyreotic patients receiving TSH suppression therapy; however, there was a significant tendency towards thyrotoxicosis only when TSH was strongly suppressed (ALP [p < 0.05] and pulse rate [p < 0.05]). The effects of endogenous SHyper and TSH suppression therapy on target organ function are different. Although the serum thyroid hormone profile is similar to that of the thyrotoxic state, athyreotic patients receiving TSH suppression therapy with mildly suppressed serum TSH levels are not thyrotoxic.
亚临床甲状腺功能亢进症（SHyper）的定义是游离甲状腺素（fT4）和游离三碘甲状腺原氨酸（fT3）水平正常，但促甲状腺激素（TSH）水平受到抑制。既往研究报道了内源性SHyper患者以及接受左甲状腺素促甲状腺激素抑制治疗的甲状腺切除患者的个体病理生理学情况；然而，显然尚无研究对这两种情况进行比较。选取了540例未经治疗的内源性SHyper患者以及1024例因乳头状甲状腺癌接受甲状腺全切术并接受促甲状腺激素抑制治疗的患者。对内源性SHyper患者、接受促甲状腺激素抑制治疗的甲状腺切除患者以及健康参与者的甲状腺激素谱和与甲状腺毒症相关的外周指标进行了研究。内源性SHyper患者的甲状腺激素水平显著更高（fT4 [p < 0.001]和fT3 [p < 0.001]），并且外周指标显示出明显的甲状腺毒症倾向（TSH强烈抑制：碱性磷酸酶[ALP，p < 0.001]、肌酐[Cre，p < 0.001]、脉搏率[p < 0.05]；TSH轻度抑制：Cre [p < 0.05]），高于健康参与者。相比之下，接受促甲状腺激素抑制治疗的甲状腺切除患者仅在TSH受到强烈抑制时（fT3 [p < 0.001]和Cre [p < 0.001]）才显示出比健康参与者更明显的甲状腺毒症倾向。内源性SHyper患者的fT3水平显著高于接受促甲状腺激素抑制治疗的甲状腺切除患者（p < 0.001）；然而，仅在TSH受到强烈抑制时才有明显的甲状腺毒症倾向（ALP [p < 0.05]和脉搏率[p < 0.05]）。内源性SHyper和促甲状腺激素抑制治疗对靶器官功能的影响不同。尽管血清甲状腺激素谱与甲状腺毒症状态相似，但血清TSH水平轻度受抑制且接受促甲状腺激素抑制治疗的甲状腺切除患者并无甲状腺毒症。
