促甲状腺激素与甲状腺功能正常人群中甲状腺结节的相关性

Association between thyroid-stimulating hormone and thyroid nodules in people with normal thyroid function

摘要:

目的调查甲状腺功能正常个体中促甲状腺激素(thyroid-stimulating hormone, TSH)水平与甲状腺结节(thyroid nodules, TN)之间的关系。 方法以2022年9月—2023年9月广东省南方医科大学南方医院健康管理中心基线数据完整的3 416名健康成人为研究对象。通过Logistic回归模型分析TSH及其三分位数组与TN的相关性，并进行亚组分析。 结果与非TN组相比，TN在女性、41岁以上年龄组、游离三碘甲状腺原氨酸/游离甲状腺素(free triiodothyronine/free thyroxine, FT3/FT4)异常组更常见，TN组游离三碘甲状腺原氨酸(free triiodothyronine, FT3)、TSH、甘油三酯(triglyceride, TG)、尿酸(uric acid, UA)、白蛋白(total protein, ALB)水平更低，高密度脂蛋白胆固醇(high density lipoprotein, HDL-C)水平、收缩压(systolic blood pressure, SBP)更高(P<0.05)。多因素Logistic分析提示，低TSH水平人群的TN检出风险显著增加(P<0.001)。TSH三分位数组中，低TSH组的TN检出风险是高TSH组的1.980倍(P<0.001)。TSH与TN检出风险关联的亚组分析中未发现TSH与其他基线特征存在显著交互作用(交互P>0.05)。 结论在甲状腺功能正常人群中，低血清TSH水平与TN检出风险增加相关，提示健康体检中应重点关注41岁以上低TSH人群的甲状腺健康。

Abstract:

ObjectiveTo investigate the relationship between thyroid-stimulating hormone(TSH) levels and thyroid nodules(TN) in euthyroid populations. MethodsA total of 3 416 healthy adults with complete baseline data from a hospital health management center in Guangdong Province from September 2022 to September 2023 were considered as the study subjects. The logistic regression models were applied to investigate the correlations between TSH levels and their tertiles with TNs. Subgroup analyses were performed based on different stratifications. ResultsCompared to the non-TN group, TNs were more common in women, the age group over 41 years, and the free triiodothyronine/free thyroxine ratio(FT3/FT4) abnormal group. The levels of FT3, TSH, triglyceride(TG), uric acid(UA), and albumin(ALB) were even lower in TN group; additionally, the high density lipoprotein(HDL-C) level and systolic blood pressure(SBP) were much higher(all P<0.05). After adjusting for confounding factors, individuals with low TSH levels had a significantly increased risk of TN detection(P<0.001). In the TSH tertile groups, the low TSH group had a 1.980-fold higher risk of TN detection compared to the high TSH group(P<0.001). No significant interaction of TSH with other baseline characteristics was found in the subgroup analysis of TSH and TN detected risk associations(interaction P>0.05). ConclusionIn euthyroid individuals, low serum TSH levels are associated with an increased risk of TN detection, suggesting that greater attention should be paid to thyroid health in individuals over 40 years old with low TSH levels during health examinations.