| Objective:This study aimed to examine the change in thyroid-stimulating hormone(TSH)concentration over age in China and investigate the relationship between TSH and risk factors for cardiovascular disease(CVD)among euthyroid subjects.Design:A cross-sectional study.Patients and Measurements:A total of 7693 healthy people who underwent routine physical examination at the Nanjing Drum Tower Hosppital from January 1,2016 to December 31,2016 were collected.Body height,body weight,systolic blood pressure and diastolic blood pressure were measured,body mass index was calculated,and blood lipids,blood glucose,TSH,free triiodothyronine(FT3),free thyroxine(FT4)were also measured.According to the age,the 7693 people who were enrolled were divided into 20-29,30-39,40-49,50-59,60-69,and ?70 years old groups.The median,2.5th and 97.5th percentile TSH levels of each age group were calculated,and the median TSH levels of each age group were compared.The associations between TSH and CVD risk factor [age,body mass index(BMI),systolic and diastolic blood pressure,total cholesterol(TC),triglycerides,low density(LDL-C)and high density lipoprotein-cholesterol(HDL-C)and fasting plasma glucose(FPG)] were evaluated with Pearson correlation analysis.The TSH within the new reference range were divided into five groups according to the quintiles.The relationship between different TSH levels and CVD risk factors in the group aged less than 60 years,60-69 years old,and 70 years old was analyzed.Results:1.Serum TSH levels were positively correlated with age,systolic blood pressure,diastolic blood pressure,TC and LDL-C(both p<0.05.Serum TSH levels were negatively correlated with FT3 and FT4(both p<0.001).There was no correlation between TSH and BMI,FPG,TG and HDL-C(p>0.05).2.The median level of serum TSH was 2.25,2.10,2.15,2.26,2.35 and 2.39 mIU/L in the age group of 20-29,30-39,40-49,50-59,60-69 and ?70,respectively.The median level of serum TSH increased with age(trend P<0.05),and the median level of TSH was highest in the age group ?70 years.The 2.5th percentiles in the 20-29,30-39,40-49,50-59,60-69,and ?70 age groups were 0.77,0.74,0.82,0.88,0.81,and 0.78 mIU/ L.The 2.5th percentile in the 60-69 age group and the ?70 age group did not change with age.The 97.5th percentile of TSH levels increased with age,with 5.07 mIU/L for 20-29 years old,5.22 mIU/L for 30-39 years old,6.03 mIU/L for 40-49 years old,and 6.26 years old for 50-59 years old.mIU/L,6.83 mIU/L for 60-69 years old and 8.07 mIU/L for groups ?70 years old.3.All subjects were reclassified according to the upper limit of the serum TSH reference range(97.5th percentile)for different age groups.6.9%,3.7%,7.0%,8.0%,and 9.7% of subjects aged 20-29,30-39,40-49,50-59,and 60-69 were reclassification from thyroid dysfunction group to normal thyroid function group.4.In the <60 age group,the 60-69 age group,and the ?70 age group,the TSH reference values ranged from 0.82-5.62 mIU/L,0.81-6.83 mIU/L,and 0.78-8.07 mIU/L,respectively.The TSH within the new reference range were divided into five groups according to the quintiles.The range of TSH reference values in the age group of 60 years is further divided into five groups: Q1 0.82-1.47 mIU/L,Q2 1.48-1.92 mIU/L,Q3 1.93-2.47 mIU/L,Q4 2.48-3.32 mIU/L,Q5 3.33-5.62 mIU/L;systolic blood pressure,TC and LDL-C gradually increased with increasing serum TSH levels(both p<0.05).There were no significant differences in BMI,diastolic blood pressure,FPG,TG and HDL-C levels between the five groups with increasing TSH levels(all p>0.05).The serum TSH levels of the 60-69 age group were divided into five groups(Q1 0.81-1.49 mIU/L,Q2 1.50-2.04 mIU/L,Q3 2.05-2.66 mIU/L,Q4 2.67-3.56 mIU/L,Q5).3.57-6.83 mIU/L).With the increase of serum TSH level,there was no significant change in age,BMI,systolic blood pressure,diastolic blood pressure,fasting blood glucose and blood lipid profile.Serum TSH levels in the age group of ?70 years were divided into five groups according to quintiles: Q1 0.78-1.50 mIU/L,Q2 1.51-2.11 mIU/L,Q3 2.12-2.77 mIU/L,Q4 2.78-3.90 mIU/L,Q5 3.91-8.07 mIU/L,age,BMI,systolic blood pressure,diastolic blood pressure,fasting blood glucose and blood lipid profile did not change with TSH.Conclusions:Serum TSH concentration increases over age.There were no significant differences in BMI,blood pressure,lipid profile or FPG among subjects 60–69 and older than or equal to 70 years.Elevated TSH within new reference range is associated with risk factors for CVD in subjects aged <60 years.Thus,there might be age-related difference in the relationship between CVD risk factors and elevated serum TSH.Objective:Hashimoto thyroiditis(HT),also known as chronic lymphocytic thyroiditis,is a type of autoimmune thyroiditis.In recent years,its incidence rate is on the rise.The thyroid function of patients at the time of treatment may be hyperthyroidism,hypothyroidism or normal thyroid function,and the clinical manifestations are complex and diverse.Anti-thyroperoxidase antibodies(TPOAb)and anti-thyroglobulin antibodies(TGAb)are hallmark antibodies to HT.Due to the decline of decreased autoimmune function and hypothalamic-pituitary-thyroid axis regulation,the incidence of HT is significantly increased,but there are no obvious symptoms,long course,slow development,and easy to be ignored.Therefore,the evaluation of HT autoantibodies and thyroid function parameters in the elderly [including thyroid stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4)] relationship is critical for early diagnosis and early treatment of thyroid dysfunction in the elderly.The aim of this study was to investigate the relationship between HT autoantibodies and thyroid function in the elderly.Patients and Measurements: Healthy people who were tested for thyroid function and thyroid autoantibodies at the Nanjing Drum Tower Hosppital from January 2016 to December 2017 were enrolled to detect serological markers such as TSH,FT3,FT4,TPOAb and TGAb.According to the exclusion criteria,1898 subjects were screened,including 586 males and 1312 females.According to age,they were divided into the elderly group(?60 years old age group)and the non-elderly group(<60 years old age group);they were divided into positive and negative groups according to whether the thyroid autoantibodies were positive or not.Positive or negative thyroid autoantibodies were assessed with TPOAb and TGAb.Thyroid function status was assessed by TSH and FT4.Results:(1)The detection rates of TPOAb positive,TGAb positive and TPOAb+TGAb double positive in the general population were 17.6%,17.1% and 10.4%,respectively.In the elderly group,the detection rates of TPOAb positive,TGAb positive,and TPOAb+TGAb double positive were 14.38%,14.52%,and 7.53%,respectively.In the non-elderly group,the detection rates of TPOAb positive,TGAb positive,and TPOAb+TGAb double positive were 19.6%,18.6% and 12.2%,respectively.The detection rates of TPOAb positive,TGAb positive and TPOAb+TGAb double positive in the elderly group were lower than those in the non-elderly group(P<0.05).(2)Regardless of the elderly group or the non-elderly group,TPOAb positive,TGAb positive,TPOAb+TGAb double positive group TSH concentration was significantly higher than the corresponding antibody negative group(P<0.05),while FT3 and FT4 concentrations were decreased than the corresponding antibody negative group(P<0.05).(3)In the non-elderly group,the TSH level of the TPOAb+TGAb double positive group was significantly higher than that of the TPOAb positive group(P<0.05),while the older group was positive for TPOAb,TGAb and TPOAb+TGAb.There was no significant difference between the TSH levels between TPOAb,TGAb and TPOAb+TGAb group in the elderly group(P>0.05).(4)Regardless of the elderly group or the non-elderly group,the detection rates of thyroid dysfunction(hypothyroidism or subclinical hypothyroidism)in the TPOAb-positive,TGAb-positive,and TPOAb+TGAb double-positive subgroups were higher than the corresponding antibody-negative subgroups(both P< 0.05).(5)Regardless of the elderly group or the non-elderly group,the thyroid autoantibody positive subgroup(TPOAb positive,TGAb positive and TPOAb+TGAb double positive)had the highest prevalence of subclinical hypothyroidism.However,there was no statistically significant difference in the detection rates of hyperthyroidism,subclinical hyperthyroidism,hypothyroidism,subclinical hypothyroidism,and normal thyroid function among the three subgroups(P>0.05).(6)In the TPOAb-positive group,the subclinical hypothyroidism detection rate in the elderly group was lower than that in the non-elderly group(P<0.05),while the normal thyroid function detection rate was higher than the non-elderly group(P<0.05).(7)There was a positive correlation between serum TPOAb,TGAb and TSH in the elderly group(r=0.243,P<0.05,r=0.168,P<0.05),but negatively correlated with FT3 and FT4(r=-0.089,P< 0.05;r =-0.123,P < 0.05;r =-0.135,P < 0.05;r =-0.080,P < 0.05).There was a positive correlation between TPOAb,TGAb and TSH in the serum of non-elderly group(r=0.225,P<0.05;r=0.141,P<0.05).(8)TPOAb positive and TPOAb+TGAb double positive in the elderly group were risk factors for clinical hypothyroidism(OR = 5.688,12.667,P < 0.05).In the non-elderly group,TPOAb+TGAb double positive was a risk factor for subclinical hypothyroidism(OR=3.568,P < 0.05).Both TGAb positive and TPOAb+TGAb double positive were risk factors for clinical hypothyroidism(OR=13.095,33.608,P < 0.05).Conclusions:Hashimoto's thyroiditis often causes thyroid dysfunction.The detection rate of thyroid dysfunction(hypothyroidism and subclinical hypothyroidism)in the elderly TPOAb-positive group,TGAb-positive group and TPOAb+TGAb double-positive group is significantly higher than the corresponding antibody negative group.TPOAb+TGAb double positive is a risk factor for clinical hypothyroidism in the elderly,and is also a risk factor for subclinical hypothyroidism and clinical hypothyroidism in non-elderly patients.Therefore,the follow-up and monitoring of the autoantibody TPOAb+TGAb of Hashimoto's thyroiditis in the elderly is beneficial to the early diagnosis and treatment of thyroid diseases. |
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