亚临床甲状腺功能亢进与心血管疾病及全因死亡：荷兰大型初级保健队列研究
该回顾性队列研究基于荷兰PHARMO数据网络2012-2021年初级保健数据，纳入生化确诊的亚临床甲状腺功能亢进（SHT）患者11,163例，与按年龄、性别和全科医生匹配的甲状腺功能正常对照46,058例比较。结果显示SHT与房颤（HR 1.37）、心力衰竭（HR 1.21）和全因死亡（HR 1.51）风险升高相关，且年轻患者（30-49岁）的相对风险更高。
要点
- SHT患者房颤风险显著增加，尤其TSH<0.1 mU/L者风险更高。
- SHT与心衰风险轻度升高相关，女性和30-49岁人群风险更明显。
- SHT患者全因死亡风险升高，年轻患者相对风险更高，提示需个体化风险评估。
核心结论
- SHT与房颤、心衰及全因死亡风险增加相关，且年轻患者相对风险更高，挑战了传统关注老年人群的观点。
研究设计与样本
- 回顾性队列研究，使用荷兰PHARMO数据网络全科医生数据（2012-2021年），SHT患者n=11,163，匹配甲状腺功能正常对照n=46,058。
主要发现
- 房颤风险显著增加（HR 1.37，95%CI 1.22-1.55），TSH<0.1 mU/L者HR 1.60（1.32-1.94），30-49岁者HR 1.88（1.05-3.36）。
- 心衰风险轻度升高（HR 1.21，1.04-1.40），30-49岁者HR 3.74（1.52-9.24），女性HR 1.31（1.10-1.56）。
- 全因死亡风险升高（HR 1.51，1.38-1.64），男性HR 1.75（1.50-2.05），30-49岁者HR 2.95（1.73-5.04）。
- 动脉粥样硬化并发症关联较弱（HR 1.12，1.00-1.24）。
关键数值与推荐
- SHT定义为TSH抑制伴游离T4正常。
- 风险估计采用多变量校正Cox回归模型，校正相关混杂因素。
临床怎么用
- 对SHT患者应评估房颤、心衰和死亡风险，尤其年轻患者和TSH显著抑制者，考虑个体化监测与干预。
局限性
- 缺乏吸烟和饮酒数据，合并症病史仅能评估入组前一年，可能存在残余混杂。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: Subclinical hyperthyroidism (SHT) has been associated with adverse cardiovascular outcomes, but the magnitude and consistency of these risks, particularly across demographic subgroups, remain unclear. METHODS: We conducted a retrospective cohort study using general practitioner (GP) data from the PHARMO Data Network in the Netherlands (2012-2021). Patients with biochemically confirmed SHT (suppressed thyrotropin [TSH] with normal fT4; n = 11,163) were compared with a matched euthyroid reference group (n = 46,058) based on age, sex, and GP practice. Incidence of atherosclerotic complications, atrial fibrillation (AF), heart failure (HF), and all-cause mortality were assessed. Multivariable-adjusted Cox regression models estimated hazard ratios (HRs), adjusting for relevant confounders. Due to data limitations, information on smoking and alcohol use was not available, and medical history concerning comorbid conditions could only be assessed for the one-year period prior to cohort entry. RESULTS: SHT was associated with a significantly increased risk of AF (HR: 1.37, 95% CI: 1.22-1.55), particularly in those with TSH < 0.1 mU/L (HR: 1.60, 1.32-1.94) and in individuals aged 30-49 years (HR 1.88, 1.05-3.36). HF risk was modestly elevated overall (HR: 1.21, 1.04-1.40), with stronger effects in individuals aged 30-49 years (HR: 3.74, 1.52-9.24) and women (HR: 1.31, 1.10-1.56). All-cause mortality was higher in the SHT group (HR: 1.51, 1.38-1.64), especially in men (HR: 1.75, 1.50-2.05) and individuals aged 30-49 years (HR: 2.95, 1.73-5.04). The association with atherosclerotic complications was weak-to-modest (HR: 1.12, 1.00-1.24). CONCLUSIONS: SHT is linked to increased risks of AF, HF, and all-cause mortality, with higher relative risks in younger patients. These findings challenge the traditional focus on older populations and underscore the need for individualized risk assessment in SHT.
引用
- Ursem SR, Noordam R, van den Berg JM, et al. Subclinical Hyperthyroidism, Cardiovascular Disease and All-Cause Mortality: Insights from a Large Dutch Primary Care Cohort Study. Thyroid. 2026. PMID: 42100953. doi:10.1177/10507256261449444
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。