Suppr
超能文献

墨西哥一家公立医院人群中亚临床甲状腺功能减退症的进展：一项回顾性队列研究

Progression of Subclinical Hypothyroidism in a Mexican Public Hospital Population: A Retrospective Cohort Study.

作者信息

Violante-Ortiz Rafael, Fernández-Ordóñez Norma, Narvaez Gallifa Emanuel, Hernandez Molina Erick E, Guerra Cardenas Jose E, Reyna-Beltrán Elizabeth, Castillo Hernández Dylan, Díaz Martínez Luis S, Badillo Grijalva Izmene N, Bautista Sánchez Jaidy M

机构信息

Endocrinology and Metabolism, Facultad de Medicina de Tampico "Dr. Alberto Romo Caballero" Universidad Autónoma de Tamaulipas, Tampico, MEX.

Endocrinology and Metabolism, Centro de Estudios de Investigación Metabólicos y Cardiovasculares, S.C., Madero, MEX.

出版信息

Cureus. 2025 Apr 24;17(4):e82923. doi: 10.7759/cureus.82923. eCollection 2025 Apr.

DOI:10.7759/cureus.82923

PMID:40276627

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12021256/

Abstract

BACKGROUND AND AIM

Treatment of subclinical hypothyroidism (SCH) is controversial. The uncertainty of the levels of thyroid-stimulating hormone (TSH) that warrant treatment and the risk of progression to overt hypothyroidism may lead to overtreatment. This study aimed to assess the persistence of SCH and its short-term progression to overt hypothyroidism in patients referred to an outpatient endocrinology clinic in Southern Tamaulipas, Mexico, and to identify predictive factors for progression to overt hypothyroidism.

METHODS

This analytic, observational, and retrospective study analyzed records from 1100 patients at a Mexican public hospital between 2018 and 2019. Exclusion criteria included prior hypothyroidism, levothyroxine use, pregnancy, TSH ≥10.0 mIU/L, age <18 years, and non-completion of follow-up. A final sample of 222 patients with SCH (defined as TSH >4.2 and <10.0 mIU/L, with normal T4 levels) was followed for three months, assessing the regression, persistence, and progression of TSH levels. Statistical analyses included a chi-squared test and Student's t-test. Statistical significance was set at alpha=0.05.

RESULTS

The study included 181 (81.5%) females with a mean age of 49.7 years (±13.5). After three months, 158 (71.2%) patients regressed to euthyroidism, 47 (21.2%) remained subclinically hypothyroid, and 17 (7.6%) progressed to overt hypothyroidism. The highest progression rate to overt hypothyroidism (16.0%) was observed in patients with initial TSH levels >6.0 to ≤8.0 mIU/L (relative risk: 5.4; 95% confidence interval {CI}: 1.83-16.0, p<0.001). Mean baseline TSH levels were 6.57±1.11 mIU/L (95% CI: 6.00-7.15, p<0.001) in those who progressed to overt hypothyroidism. No association was observed between symptoms and disease progression.

CONCLUSION

Most patients with SCH regressed to an euthyroid state without treatment in the short term, supporting a monitoring-first approach.

摘要

背景与目的

亚临床甲状腺功能减退症（SCH）的治疗存在争议。甲状腺刺激激素（TSH）水平是否需要治疗存在不确定性，以及进展为显性甲状腺功能减退症的风险可能导致过度治疗。本研究旨在评估墨西哥塔毛利帕斯州南部一家门诊内分泌诊所收治的患者中SCH的持续情况及其短期进展为显性甲状腺功能减退症的情况，并确定进展为显性甲状腺功能减退症的预测因素。

方法

本分析性、观察性和回顾性研究分析了2018年至2019年期间墨西哥一家公立医院1100例患者的记录。排除标准包括既往甲状腺功能减退症、使用左甲状腺素、妊娠、TSH≥10.0 mIU/L、年龄<18岁以及未完成随访。对222例SCH患者（定义为TSH>4.2且<10.0 mIU/L，T4水平正常）的最终样本进行了为期三个月的随访，评估TSH水平的回归、持续和进展情况。统计分析包括卡方检验和学生t检验。设定统计学显著性水平为α=0.05。

结果

该研究纳入了181例（81.5%）女性，平均年龄为49.7岁（±13.5）。三个月后，158例（71.2%）患者恢复为甲状腺功能正常，47例（21.2%）仍为亚临床甲状腺功能减退，17例（7.6%）进展为显性甲状腺功能减退。初始TSH水平>6.0至≤8.0 mIU/L的患者中观察到最高的显性甲状腺功能减退进展率（16.0%）（相对风险：5.4；95%置信区间{CI}：1.83 - 16.0，p<0.001）。进展为显性甲状腺功能减退症的患者平均基线TSH水平为6.57±1.11 mIU/L（95% CI：6.00 - 7.15，p<0.001）。未观察到症状与疾病进展之间的关联。