Corsello Andrea, Cacciamani Fanelli Piergiacomo Maria, Lener Luisa, Cera Gianluca, Locantore Pietro, Pontecorvi Alfredo, Corsello Salvatore Maria, Paragliola Rosa Maria
Unit of Endocrine Surgery, Ospedale Isola Tiberina-Gemelli Isola, 00186 Rome, Italy.
Unit of Endocrinology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico "A. Gemelli" IRCCS, 00136 Rome, Italy.
Int J Mol Sci. 2025 Apr 28;26(9):4176. doi: 10.3390/ijms26094176.
Subacute thyroiditis (SAT) represents an inflammatory disease of the thyroid gland, often resulting from viral infections or post-viral inflammatory responses. Long-term hypothyroidism is a possible evolution, requiring frequent follow-up and, if necessary, levothyroxine (LT4) replacement therapy. We retrospectively included 139 patients (out of 428) with SAT referring to the "Fondazione Policlinico Universitario A. Gemelli IRCCS" (Rome), between 2010 and 2022 to identify predictive parameters for long-term hypothyroidism. We evaluated TSH, FT4, and FT3 at four timepoints (diagnosis, 4-8 weeks, 10-20 weeks, and 28-54 weeks). We started LT4 therapy in patients with TSH > 10 μUI/mL or between 4-10 μUI/mL, with symptoms of hypothyroidism. "Long-term hypothyroidism" was defined as TSH > 4 μUI/mL after LT4 reduction and/or withdrawal. Univariate analysis showed correlations between long-term hypothyroidism and higher FT3 and FT4 and positive anti-Tg Abs at diagnosis and higher changes in TSH values (ΔTSH), decreased thyroid volume, and persistence of hypoechoic areas during follow-up. Furthermore, more severe thyrotoxicosis at presentation may be associated with a faster progression to hypothyroidism, likely due to greater thyroid damage. Multivariable analysis found ΔTSH (TP2-TP1) as an independent predictor of hypothyroidism. We propose specific biochemical and ultrasonographic parameters at diagnosis and during follow-up as possible predictors of long-term hypothyroidism after SAT, reducing treatment and healthcare costs for most patients who will never require replacement therapy.
亚急性甲状腺炎（SAT）是一种甲状腺的炎症性疾病，通常由病毒感染或病毒感染后的炎症反应引起。长期甲状腺功能减退是一种可能的演变结果，需要定期随访，必要时进行左甲状腺素（LT4）替代治疗。我们回顾性纳入了2010年至2022年间在“罗马圣心天主教大学综合医院A. Gemelli IRCCS”就诊的428例SAT患者中的139例，以确定长期甲状腺功能减退的预测参数。我们在四个时间点（诊断时、4 - 8周、10 - 20周和28 - 54周）评估促甲状腺激素（TSH）、游离甲状腺素（FT4）和游离三碘甲状腺原氨酸（FT3）。对于TSH>10 μUI/mL或4 - 10 μUI/mL且有甲状腺功能减退症状的患者，我们开始使用LT4治疗。“长期甲状腺功能减退”定义为在LT4减量和/或停药后TSH>4 μUI/mL。单因素分析显示，长期甲状腺功能减退与诊断时较高的FT3和FT4、抗甲状腺球蛋白抗体（anti-Tg Abs）阳性、TSH值的较高变化（ΔTSH）、甲状腺体积减小以及随访期间低回声区的持续存在相关。此外，就诊时更严重的甲状腺毒症可能与更快进展为甲状腺功能减退有关，这可能是由于甲状腺损伤更大。多变量分析发现ΔTSH（TP2 - TP1）是甲状腺功能减退的独立预测因子。我们提出在诊断时和随访期间的特定生化和超声参数，作为SAT后长期甲状腺功能减退的可能预测指标，从而为大多数永远不需要替代治疗的患者降低治疗和医疗成本。
