BACKGROUND & AIMS:
:Subclinical hypothyroidism usually is asymptomatic, but it can be associated with various adverse cardiologic outcomes. With the objective of gaining insight into the role of thyroid-stimulating hormone (TSH) in congenital heart abnormalities, this study measured serum TSH concentrations in different subtypes of grown-up congenital heart disease (GUCHD) patients. Serum TSH (reference range, 0.34-5.6 mIU/L), creatinine, cholesterol, C-reactive protein (CRP), N-terminal proB-type natriuretic peptide (NT-pro-BNP), and 24-h proteinuria were measured in 249 GUCHD patients. Of 24 GUCHD patients (9.6 %) with a TSH level higher than 5.6 mUI/L, nine were cyanotic (37.5 %) and seven (29.1 %) had Down syndrome. The GUCHD patients with serum TSH exceeding 5.6 mIU/L had a significantly higher level of serum NT-pro-BNP (195.1 [0.28; 5,280.3] vs 57.6 [0.00; 929.8]; p = 0.001) and CRP (0.30 [0.06; 1.87] vs 0.16 [0.00; 1.40]; p = 0.011] than those with a TSH level of 5.6 mIU/L or lower. No significant differences were found in serum creatinine, lipids, or 24-h proteinuria between the two groups. The T4 concentrations in the GUCHD patients with TSH exceeding 5.6 mIU/L were within the normal range (0.89 ± 0.23 ng/dL). In the multivariate analysis, cyanosis (odds ratio [OR], 6,399; 95 % confidence interval [CI] 2,296-17,830; p < 0.001), Down syndrome (OR, 6,208; 95 % CI, 1,963-19,636; p = 0.002), and NT-pro-BNP concentrations (OR, 1,001; 95 % CI, 1,000-1,002; p < 0.026) proved to be risk factors for TSH levels higher than 5.6 mIU/L. Because subclinical hypothyroidism entails a cardiovascular risk, the authors postulate that TSH screening should be included in the routine follow-up evaluation of GUCHD patients with cyanosis or Down syndrome.
背景与目标:
亚临床甲状腺功能减退症通常无症状,但可能与各种不良心脏预后相关。为了深入了解甲状腺刺激激素(TSH)在先天性心脏病中的作用,本研究测量了不同类型的成年先天性心脏病(GUCHD)患者的血清TSH浓度。测量血清TSH(参考范围0.34-5.6 mIU / L),肌酐,胆固醇,C反应蛋白(CRP),N端proB型利钠肽(NT-pro-BNP)和24小时蛋白尿。 249位GUCHD患者。 TSH水平高于5.6 mUI / L的24名GUCHD患者(9.6%)中,有9名发(37.5%)和7名(29.1%)患有唐氏综合症。血清TSH超过5.6 mIU / L的GUCHD患者的血清NT-pro-BNP显着更高(195.1 [0.28; 5,280.3] vs 57.6 [0.00; 929.8]; p = 0.001)和CRP(0.30 [0.06; 1.87) [] vs. 0.16 [0.00; 1.40]; p = 0.011],TSH水平为5.6 mIU / L或更低;两组之间的血清肌酐,脂质或24小时蛋白尿无显着差异。 TSH超过5.6 mIU / L的GUCHD患者的血药浓度在正常范围内(0.89±0.23 ng / dL)。在多变量分析中,发osis(优势比[OR]为6,399; 95%置信区间[CI]为2,296- 17,830; p <0.001),唐氏综合症(OR,6,208; 95%CI,1,963-19,636; p = 0.002)和NT-pro-BNP浓度(OR,1,001; 95%CI,1,000-1,002; p <0.026) )被证明是TSH水平高于5.6 mIU / L的危险因素。由于亚临床甲状腺功能减退症会引起心血管疾病风险,因此作者推测TSH筛查应包括在GUCHD的常规随访评估中紫osis或唐氏综合症患者。