Sherman S I, Simonson L, Ladenson P W
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Med. 1996 Aug;101(2):192-8. doi: 10.1016/s0002-9343(96)80076-3.
To identify the clinical, demographic, and hormonal features that characterize and place patients at greater risk for complicated thyrotoxicosis.
Fifty-nine patients with documented thyrotoxicosis complicated by cardiovascular, neuropsychiatric, gastrointestinal, or thermoregulatory dysfunction, were retrospectively identified among 498,000 hospital admissions between 1979 and 1992. Clinical, demographic, and hormonal information were obtained from these charts, as well as from the charts of 118 randomly selected thyrotoxic outpatients.
Age distribution of complicated thyrotoxicosis patients was bimodal, with a median of 41 years. Forty-nine percent of patients had been previously diagnosed with thyrotoxicosis, but most had been noncompliant with prescribed medication. Cardiovascular complications were among the primary causes for admission in 46% of patients, followed by neuropsychiatric indications in 42%, fever in 34%, and gastrointestinal dysfunction in 17%. Only 8% had primary involvement of > 2 organ systems. There was high correlation between organ systems with pre-existing dysfunction and those with a complication of thyrotoxicosis (P < 0.0001). Compared to uncomplicated controls, patients with complicated thyrotoxicosis were more likely to be uninsured or covered by Medicaid (OR, 2.64; 95% CI 1.78 to 3.91); to be < 30 or > 50 years old (OR, 1.93; 95% CI 1.23 to 3.03); and to have serum T4 concentrations greater than twice the upper limit of normal (OR, 1.67; 95% CI, 1.15 to 2.44).
Certain thyrotoxic patients are at greater risk for developing complications. By addressing the medical needs of these patients, it may be possible to reduce the likelihood of complications requiring hospitalization.
确定具有特征性且使患者发生复杂甲状腺毒症风险更高的临床、人口统计学和激素特征。
在1979年至1992年间的498,000例住院患者中，回顾性确定了59例有记录的并发心血管、神经精神、胃肠道或体温调节功能障碍的甲状腺毒症患者。从这些病历以及118例随机选择的甲状腺毒症门诊患者的病历中获取临床、人口统计学和激素信息。
复杂甲状腺毒症患者的年龄分布呈双峰型，中位数为41岁。49%的患者先前已被诊断为甲状腺毒症，但大多数患者未遵医嘱服药。心血管并发症是46%患者入院的主要原因，其次是神经精神症状（42%）、发热（34%）和胃肠道功能障碍（17%）。仅有8%的患者有超过2个器官系统的原发性受累。已有功能障碍的器官系统与发生甲状腺毒症并发症的器官系统之间存在高度相关性（P<0.0001）。与无并发症的对照组相比，复杂甲状腺毒症患者更可能未参保或由医疗补助计划承保（比值比[OR]，2.64；95%置信区间[CI]为1.78至3.91）；年龄小于30岁或大于50岁（OR，1.93；95%CI为1.23至3.03）；血清总甲状腺素（T4）浓度大于正常上限的两倍（OR，1.67；95%CI为1.15至2.44）。
某些甲状腺毒症患者发生并发症的风险更高。通过满足这些患者的医疗需求，可能降低需要住院治疗的并发症的发生可能性。
