Chiovato L, Larizza D, Bendinelli G, Tonacchera M, Marinó M, Mammoli C, Lorini R, Severi F, Pinchera A
Istituto di Endocrinologia, Università di Pisa, Italy.
Eur J Endocrinol. 1996 May;134(5):568-75. doi: 10.1530/eje.0.1340568.
A high prevalence of autoimmune thyroid disease (AITD) has been described in Turner's syndrome (TS) but the extent of this association is controversial for the prevalence of thyroid autoantibody and the clinical impact of thyroid dysfunction. In this study we searched for thyroid disease and thyroid autoantibodies in patients with TS. Seventy-five unselected TS patients (age range 3-30 years) were studied. Sera were tested for thyroid hormones, thyrotropin (TSH), thyroglobulin (TG-ab) and thyroperoxidase (TPO-ab) antibodies. The TSH-receptor antibodies with thyroid-stimulating (TS-ab) or TSH-blocking activity (TSHB-ab) were measured in the IgG fraction using a bioassay. Ten out of 75 (13.3%) TS patients had AITD: eight had autoimmune thyroiditis (AT) (six with subclinical and two with overt hypothyroidism and one with euthyroidism) and one had Graves' disease. The prevalence of AITD increased significantly (p < 0.05) from the first (15%) to the third (30%) decade of life. The prevalence of TPO-ab and/or TG-ab (20%) was higher (p < 0.05) in TS than in age-matched female controls and increased from the first (15%) to the third (30%) decade of life. Clinical AITD was diagnosed in 46% of TS patients with TPO-ab and/or TG-ab. Thyroid-stimulating antibody was detected in the hyperthyroid patient, and TSHB-ab was found in one of eight patients with hypothyroid AT. It was concluded that: TS patients are at higher than average risk of developing AITD not only in adolescence and adult age but also in childhood; hypothyroidism, mainly subclinical, is the most frequent thyroid dysfunction; elevated TPO-ab and/or TG-ab alone do not imply thyroid dysfunction; TS-ab or TSHB-ab are always associated with thyroid dysfunction although most cases of autoimmune hypothyroidism are not due to the latter antibody.
已有研究表明，特纳综合征（TS）患者中自身免疫性甲状腺疾病（AITD）的患病率较高，但这种关联的程度在甲状腺自身抗体的患病率以及甲状腺功能障碍的临床影响方面存在争议。在本研究中，我们对TS患者进行了甲状腺疾病和甲状腺自身抗体的筛查。研究了75例未经挑选的TS患者（年龄范围3至30岁）。检测血清中的甲状腺激素、促甲状腺激素（TSH）、甲状腺球蛋白（TG-ab）和甲状腺过氧化物酶（TPO-ab）抗体。使用生物测定法在IgG组分中测量具有甲状腺刺激（TS-ab）或TSH阻断活性（TSHB-ab）的TSH受体抗体。75例TS患者中有10例（13.3%）患有AITD：8例患有自身免疫性甲状腺炎（AT）（6例亚临床型、2例显性甲状腺功能减退症和1例甲状腺功能正常），1例患有格雷夫斯病。AITD的患病率从生命的第一个十年（15%）到第三个十年（30%）显著增加（p<0.05）。TS患者中TPO-ab和/或TG-ab的患病率（20%）高于年龄匹配的女性对照组（p<0.05），并从生命的第一个十年（15%）到第三个十年（30%）增加。46%的TS患者TPO-ab和/或TG-ab被诊断为临床AITD。在甲状腺功能亢进患者中检测到甲状腺刺激抗体，在8例甲状腺功能减退AT患者中有1例发现TSHB-ab。得出的结论是：TS患者不仅在青春期和成年期，而且在儿童期发生AITD的风险均高于平均水平；甲状腺功能减退症，主要是亚临床型，是最常见的甲状腺功能障碍；单独的TPO-ab和/或TG-ab升高并不意味着甲状腺功能障碍；TS-ab或TSHB-ab总是与甲状腺功能障碍相关，尽管大多数自身免疫性甲状腺功能减退症病例并非由后一种抗体引起。
