Metabolische Relevanz der autonomen Schilddrüsenfunktion

Zusammenfassung

Die Funktionslage von Patienten mit thyreoidaler Autonomie ist entweder euthyreot, subklinisch hyperthyreot oder manifest hyperthyreot. Während sowohl die fehlende metabolische Relevanz bei Euthyreose als auch die deutlichen Wirkungen der manifesten Hyperthyreose unumstritten sind, hat sich die Einschätzung der subklinisch hyperthyreoten Funktionslage in den letzten Jahren deutlich geändert: Aufgrund der negativen Auswirkungen der subklinischen Hyperthyreose auf 1. die kardiorespiratorische und zirkulatorische Funktionen mit signifikanter Erhöhung des Mortalitätsrisiko und 2. den Knochenmetabolismus mit signifikanter Anhebung des Frakturrisikos an Wirbelsäule und Femurhals sollte auch bei diesen Patienten unbedingt eine ablative Therapie angestrebt werden.

Abstract

Patients with thyroid autonomy exhibit either euthyroid or subclinical hyperthyroid or overt hyperthyroid function. The metabolic relevance of euthyroidism and overt hyperthyroidism are well defined, whereas the consequences of subclinical hyperthyroidism were revisited in the last 5-10 years. Due to the negative effects of slightly enhanced concentrations of the thyroid hormones on cardiorespiratoric and circulatoric functions in subclinical hyperthyroidism the mortality rate is significantly increased especially in the elderly, as well as the risk of hip and spine fractures. It is recommended, that all patients with thyroid autonomy and subclinical hyperthyroidism should undergo an ablative therapy.

Schlüsselwörter

Schilddrüsenautonomie - subklinische Hyperthyreose - latente Hyperthyreose - kardiovaskuläre Komplikationen - Frakturrate

Key words

Thyroid autonomy - subclinical hyperthyroidism - cardiovascular disease - increased fracture risk

Literatur

• 1 Auer J, Scheibner P, Mische T, Langsteger W, Eber O, Eber B. Subclinical hyperthyroidism as a risk factor for atrial fibrillation.  Am Heart J. 2001;  142 838-842
• 2 Biondi B, Palmieri E A, Lombardi G, Fazio S. Effects of subclinical thyroid dysfunction on the heart.  Ann Intern Med. 2002;  137 904-914
• 3 Bauer D C, Ettinger B, Nevitt M C, Stone K L. Study of Osteoporotic Fractures Research Group . Risk for fracture in women with low serum levels of thyroid-stimulating hormone.  Ann Intern Med. 2001;  134 561-568
• 4 Biondi B, Palmieri E A, Lombardi G, Fazio S. Effects of subclinical thyroid dysfunction on the heart.  Ann Intern Med. 2002;  137 904-914
• 5 Biondi B, Palmieri E A, Fazio S, Cosco C, Nocera M, Sacca L, Filetti S, Lombardi G, Perticone F. Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients.  J Clin Endocrinol Metab. 2000;  85 4701-4705
• 6 Donatelli M, Assennato P, Abbadi V, Bucalo M L, Compagno V, Lo Vecchio S, Messina L, Russo V, Schembri A, Torregrossa V, Licata G. Cardiac changes in subclinical and overt hyperthyroid women: retrospective study.  Int J Cardiol. 2003;  90 159-164
• 7 Elte J W, Bussemaker J K, Haak A. The natural history of euthyroid multinodular goitre.  Postgraduate Medical Journal. 1990;  66 186-190
• 8 Faber J, Wiinberg N, Schifter S, Mehlsen J. Haemodynamic changes following treatment of subclinical and overt hyperthyroidism.  Eur J Endocrinol. 2001;  145 391-396
• 9 Faber J, Jensen I W, Petersen L, Nygaard B, Hegedus L, Siersbaek-Nielsen K. Normalization of serum thyrotrophin by means of radioiodine treatment in subclinical hyperthyroidism: effect on bone loss in postmenopausal women.  Clin Endocrinol (Oxf). 1998;  48 285-290
• 10 Garnero P, Vassy V, Bertholin A. et al . Markers of bone turnover in hyperthyroidism and the effects of treatment.  J Clin Endocrinol Metab. 1994;  78 955-959
• 11 Greenspan S L, Greenspan F S. The effect of thyroid hormone on skeletal integrity.  Ann Intern Med. 1999;  130 750-758
• 12 Kahaly G, Hellerman J, Mohr-Kahaly S, Treese N. Impaired cardiopulmonary exercise capacity in hyperthyroidism.  Chest. 1996;  109 57-61
• 13 Kahaly G, Nieswandt J, Wagner S, Schlegel J, Mohr-Kahaly S, Hommel G. Ineffective cardiorespiratory function in hyperthyroidism.  J Clin Endocrinol Metab. 1998;  83 4075-4078
• 14 Kumeda Y, Inaba M, Tahara H. et al . Persistent increase in bone turnover in Graves' patients with subclinical hyperthyroidism.  J Clin Endocrinol Metab. 2000;  85 4157-4161
• 15 Parle J V, Maisonneuve P, Sheppard M C, Boyle P, Franklyn J A. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study.  Lancet. 2001;  15 861-865
• 16 Presti C F, Hart R G. Thyrotoxicosis, atrial fibrillation, and embolism, revisited.  Am Heart J. 1989;  117 976-977
• 17 Ross D S. Serum thyroid-stimulating hormone measurement for assessment of thyroid function and disease.  Endocrinol Metab Clin North Am. 2001;  30 245-264
• 18 Samuels M H. Subclinical thyroid disease in the elderly.  Thyroid. 1998;  8 803-813
• 19 Sandrock D, Olbricht T, Emrich D, Benker G, Reinwein D. Long-term follow-up in patients with autonomous thyroid adenoma.  Acta Endocrinol (Copenh). 1993;  128 51-55
• 20 Sawin C T, Geller A, Wolf P A, Belanger A J, Baker E, Bacharach P, Wilson P W, Benjamin E J, D'Agostino R B. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons.  N Engl J Med. 1994;  331 1249-1252
• 21 Surks M I, Ortiz E, Daniels G H, Sawin C T, Col N F, Cobin R H, Franklyn J A, Hershman J M, Burman K D, Denke M A, Gorman C, Cooper R S, Weissman N J. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.  JAMA. 2004;  291 228-238
• 22 Toft A D. Clinical practice. Subclinical hyperthyroidism.  N Engl J Med. 2001;  345 512-516
• 23 Vitti P, Rago T, Tonacchera M, Pinchera A. Toxic multinodular goiter in the elderly.  J Endocrinol Invest. 2002;  25 (Suppl 10) 16-18
• 24 Wemeau J L, Caron P, Schvartz C, Schlienger J L, Orgiazzi J, Cousty C, Vlaeminck-Guillem V. Effects of thyroid-stimulating hormone suppression with levothyroxine in reducing the volume of solitary thyroid nodules and improving extranodular nonpalpable changes: a randomized, double-blind, placebo-controlled trial by the French Thyroid Research Group.  J Clin Endocrinol Metab. 2002;  87 4928-4934