Thyroid function tests in patients taking thyroid medication in Germany: Results from the population-based Study of Health in Pomerania (SHIP)
Tóm tắt
Studies from iodine-sufficient areas have shown that a high proportion of patients taking medication for thyroid diseases have thyroid stimulating hormone (TSH) levels outside the reference range. Next to patient compliance, inadequate dosing adjustment resulting in under- and over-treatment of thyroid disease is a major cause of poor therapy outcomes. Using thyroid function tests, we aim to measure the proportions of subjects, who are under- or over-treated with thyroid medication in a previously iodine-deficient area. Data from 266 subjects participating in the population-based Study of Health in Pomerania (SHIP) were analysed. All subjects were taking thyroid medication. Serum TSH levels were measured using immunochemiluminescent procedures. TSH levels of < 0.27 or > 2.15 mIU/L in subjects younger than 50 years and < 0.19 or > 2.09 mIU/L in subjects 50 years and older, were defined as decreased or elevated, according to the established reference range for the specific study area. Our analysis revealed that 56 of 190 (29.5%) subjects treated with thyroxine had TSH levels outside the reference range (10.0% elevated, 19.5% decreased). Of the 31 subjects taking antithyroid drugs, 12 (38.7%) had TSH levels outside the reference range (9.7% elevated, 29.0% decreased). These proportions were lower in the 45 subjects receiving iodine supplementation (2.2% elevated, 8.9% decreased). Among the 3,974 SHIP participants not taking thyroid medication, TSH levels outside the reference range (2.8% elevated, 5.9% decreased) were less frequent. In concordance with previous studies in iodine-sufficient areas, our results indicate that a considerable number of patients taking thyroid medication are either under- or over-treated. Improved monitoring of these patients' TSH levels, compared to the local reference range, is recommended.
Tài liệu tham khảo
Canaris GJ, Manowitz NR, Mayor G, Ridgway EC: The Colorado thyroid disease prevalence study. Arch Intern Med. 2000, 160: 526-534. 10.1001/archinte.160.4.526.
Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE: Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002, 87: 489-499. 10.1210/jc.87.2.489.
Parle JV, Franklyn JA, Cross KW, Jones SR, Sheppard MC: Thyroxine prescription in the community: serum thyroid stimulating hormone level assays as an indicator of undertreatment or overtreatment. Br J Gen Pract. 1993, 43: 107-109.
De Whalley P: Do abnormal thyroid stimulating hormone level values result in treatment changes? A study of patients on thyroxine in one general practice. Br J Gen Pract. 1995, 45: 93-95.
Meng W, Schindler A: Iodine Supply in Germany. Elimination of Iodine Deficiency Disorders (IDD) in Central and Eastern Europe, the Commonwealth of Independent States and the Baltic States. Proceedings of a Conference held in Munich, Germany: 3-6 September 1997; Munich. Edited by: Delange F, Robertson A, McLoughney E, Gerasimov G. 1998, World Health Organization, 21-30.
WHO/UNICEF/ICCIDD: Progress Towards the Elimination of Iodine Deficiency Orders (IDD), Geneva. 1999
Meng W, Scriba PC: Jodversorgung in Deutschland. Probleme und erforderliche Maßnahmen: Update 2002. Deutsches Ärzteblatt. 2002, 99: 2560-2564.
Volzke H, Ludemann J, Robinson DM, Spieker KW, Schwahn C, Kramer A, John U, Meng W: The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid. 2003, 13: 803-810. 10.1089/105072503768499680.
John U, Greiner B, Hensel E, Ludemann J, Piek M, Sauer S, Adam C, Born G, Alte D, Greiser E, Haertel U, Hense HW, Haerting J, Willich S, Kessler C: Study of Health In Pomerania (SHIP): a health examination survey in an east German region: objectives and design. Soz Praventivmed. 2001, 46: 186-194. 10.1007/BF01324255.
Ross DS, Daniels GH, Gouveia D: The use and limitations of a chemiluminescent thyrotropin assay as a single thyroid function test in an out-patient endocrine clinic. J Clin Endocrinol Metab. 1990, 71: 764-769. 10.1210/jcem-71-3-764.
Volzke H, Alte D, Kohlmann T, Ludemann J, Nauck M, John U, Meng W: Reference intervals of serum thyroid function tests in a previously iodine-deficient area. Thyroid. 2005, 15: 279-285. 10.1089/thy.2005.15.279.
Aoki Y, Belin RM, Clickner R, Jeffries R, Phillips L, Mahaffey KR: Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey (NHANES 1999-2002). Thyroid. 2007, 17: 1211-1223. 10.1089/thy.2006.0235.
Todd CH: Management of thyroid disorders in primary care: challenges and controversies. Postgrad Med J. 2008, 85: 655-659. 10.1136/pgmj.2008.077701.
Laurberg P, Pedersen KM, Hreidarsson A, Sigfusson N, Iversen E, Knudsen PR: Iodine intake and the pattern of thyroid disorders: a comparative epidemiological study of thyroid abnormalities in the elderly in Iceland and in Jutland, Denmark. J Clin Endocrinol Metab. 1998, 83: 765-769. 10.1210/jc.83.3.765.
Reiners C, Wegscheider K, Schicha H, Theissen P, Vaupel R, Wrbitzky R, Schumm-Draeger PM: Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96,278 unselected employees. Thyroid. 2004, 14: 926-932. 10.1089/thy.2004.14.926.
Hollowell JG, Staehling NW, Hannon WH, Flanders DW, Gunter EW, Maberly GF, Braverman LE, Pino S, Miller DT, Garbe PL, DeLozier DM, Jackson RJ: Iodine nutrition in the United States. Trends and public health implications: iodine excretion data from National Health and Nutrition Examination Surveys I and III (1971-1974 and 1988-1994). J Clin Endocrinol Metab. 1998, 83: 3401-3408. 10.1210/jc.83.10.3401.
Parle JV, Franklyn JA, Cross KW, Jones SC, Sheppard MC: Prevalence and follow-up of abnormal thyrotrophin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol (Oxf). 1991, 34: 77-83. 10.1111/j.1365-2265.1991.tb01739.x.
Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witteman JC: Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med. 2000, 132: 270-278.
Morris MS, Bostom AG, Jacques PF, Selhub J, Rosenberg IH: Hyperhomocysteinemia and hypercholesterolemia associated with hypothyroidism in the third US National Health and Nutrition Examination Survey. Atherosclerosis. 2001, 155: 195-200. 10.1016/S0021-9150(00)00537-2.
Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P, Wilson PW, Benjamin EJ, D'Agostino RB: Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994, 331: 1249-1252. 10.1056/NEJM199411103311901.
Stall GM, Harris S, Sokoll LJ, Dawson-Hughes B: Accelerated bone loss in hypothyroid patients overtreated with L-thyroxine. Ann Intern Med. 1990, 113: 265-269.
Ziegler R, Schwalbe U: Schilddrüsentherapeutika. Arzneiverordnungs-Report 2008. Edited by: Schwabe U, Paffrath D. 2008, Heidelberg: Springer Medizin Verlag, 833-842. full_text.
Meikle AW: The interrelationships between thyroid dysfunction and hypogonadism in men and boys. Thyroid. 2004, 14 (Suppl 1): 17-25. 10.1089/105072504323024552.
Brabant G: Pulsatile and circadian TSH secretion. Clinical relevance?. Internist (Berl). 1998, 39: 619-622. 10.1007/s001080050223.