두경부암 환자에서 수술 및 방사선치료 후 갑상선 기능 저하

박인규,김재철,Park, In-Kyu,Kim, Jae-Cheol 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.3

목적 : 두경부암 환자에서 수술 및 수술 후 방사선치료가 갑상선 기능에 미치는 영향을 평가하기 위하여 전향적 연구를 시행하였다. 대상 및 방법 : 1986년 9월부터 1994년 12월까지 수술후 방사선치료를 받은 두경부암 환자 중 추적 관찰이 가능했던 71예를 대상으로 하였다. 환자의 연령분포는 32세부터 73세였고, 중간값은 58세였으며, 여자 12예, 남자 59예였다. 원발 병소부위는 후두가 34예로 가장 많았고, 구강 12예, 구인두 1예, 하인두 13예, 상악동 2예, 타액선 3예, 근원 불명 전이성 경부암 6예였다. 전후두절 제술 및 경부곽청수술을 시행한 환자는 45예였고, 경부곽청수술만 시행한 환자는 26예였다. 모든 환자에 대하여 방사선치료 전 및 방사선치료 후에 정기적으로 임상검사 및 갑상선 기능검사 (T3, T4, free T4, TSH, antithyroglovulin antibody, antimicrosomal antibody)를 시행하였다. 방사선량은 40.6Gy에서 60Gy였고 중간값은 50Gy였으며 추적관찰 기간은 3개월에서 80개월이었다. 결과 : 갑상선 기능 이상의 빈도는 $56.3\%(40/71)$였다. 31예 $(43.7\%)$는 갑상선 기능이 정상이었고 7예 $(9.9\%)$는 임상적 갑상선 기능저하증이었으며 33예 $(46.5\%)$는 준임상적 갑상선 기능저하증이었다. 갑상선 기능항진증, 갑상선 결절, 악성종양은 발견되지 않았다. 경부곽청수술군보다 전후두절제술 및 경부곽청수술군에서 갑상선 기능 이상이 일찍 발생하였다(p<0.05). 방사선치료 후 갑상선 기능 이상의 발생 빈도에 영향을 준 위험인자는 전후두절제술 및 경부곽청수술과 방사선치료의 병용요법 (P=0.0000)이었다. 전후두절제술 및 경부곽청수술군 45예 중 36예 $(80\%)$에서 갑상선 기능 이상이 발생하였으며 경부곽청수술군 26예 중 4예 $(15.4\%)$에서만이 갑상선 기능이상이 발생하였다. 결론 : 두경부암 환자에서 수술 및 방사선치료 후 갑상선 기능 이상은 비교적 흔한 합병증이며, 갑상선 기능 이상의 발생 빈도에 영향을 미치는 인자는 전후두절제술 및 경부곽청수술과 방사선치료의 병용요법이었다. 갑상선 기능 이상을 조기에 발견하여 치료하기 위하여 방사선치료 전 및 방사선치료 후에 정기적인 갑상선 기능검사가 필요할 것으로 사료된다. Purpose : Radiation therapy in combination with surgery has an important role in the therapy of the head and neck cancer We conducted a prospective study for patients with head and neck cancer treated with surgery and radiation to evaluate the effect of therapies on the thyroid gland, and to identify the factors that might influence the development of hypothyroidism. Materials and Methods : From September 1986 through December 1994, 71 patients with head and cancer treated with surgery and radiation were included in this prospective study. Patients' age ranged from 32 to 73 years with a median age of 58 years. There were 12 women and 59 men. The primary tumor sites were larynx in 34 patients, hypopharynx in 13 patients, oral cavity in 12 patients, unknown primary of the neck in 6 patients, salivary gland in 3 patients, maxillary sinus in 2 patients, and oropharynx in 1 patient. Total laryngectomy with neck dissection was carried out in 45 patients and neck dissection alone in 26 patients. All patients were serially monitored for thyroid function (T3, T4, free T4, TSH, antithyroglobulin antibody and antimicrosomal antibody) before and after radiation therapy. Radiation dose to the thyroid gland ranged from 40.6Gy to 60Gy with a median dose of 50Gy The follow-up duration was 3 to 80 months. Results :The overall incidence of hypothyroidism was 56.3\%$);7 out of 71 patients $(9.9\%)$ developed clinical hypothyroidism and 33 patients $(46.4\%)$ developed subclinical hypothyroidism. No thyroid nodules, thyroid cancers, or hyperthyroidism was detected. Hypothyroidism developed earlier in patients who underwent total laryngectomy with neck dissection than in patients with neck dissection alone (P<0.05). The risk factor that significantly influenced the incidence of hypothyroidism was a combination of surgery (total laryngectomy with neck dissection) and radiation therapy (P=0.0000), Four of 26 patients $(15.4\%)$ with neck dissection alone developed hypothyroidism while 36 of 45 patients $(80\%)$ with laryngectomy and neck dissection developed hypothyroidism. Conclusion : The hypothyroidism following surgery and radiation therapy was a relatively common complication. The factor that significantly influenced theincidence of hypothyroidism was combination of surgery and radiation therapy. Evaluation of thyroid function before and after radiation therapy with periodic thyroid function tests is recommended for an early detection of hypothyroidism and thyroid hormone replacement therapy is recommended whenever hypothyroidism develops.

Prevalence of hypothyroidism in patients with chronic kidney disease: a cross-sectional study from North India

( Abhilash Chandra ) 대한신장학회 2016 Kidney Research and Clinical Practice Vol.35 No.3

Background: There is an increased prevalence of hypothyroidism in chronic kidney disease (CKD) patients as the glomerular filtration rate falls. However, there is a paucity of Indian data in this respect. Methods: A cross-sectional analysis was performed based on the database of the information system of a tertiary care hospital in northern India to retrieve results of nephrology CKD outpatients (> 18 years of age) from September 2013 to October 2015 to determine the prevalence of hypothyroidism in the nonedialysis-dependent CKD population. Overt hypothyroidism was defined by a thyroid-stimulating hormone (TSH) level > 5.5 mIU/L and free T4 level < 0.89 ng/dL with clinical symptoms. Subclinical hypothyroidism was defined by a TSH level > 5.5 mIU/L and a free T4 level
0.89 ng/dL. Results: Among 1,863 CKD patients, 358 patients underwent biochemical analysis for hypothyroidism. Among these, 143 had biochemical subclinical hypothyroidism and 59 had overt hypothyroidism. Patients in the overt hypothyroid group had significantly higher TSH levels and a lower free T4 level than those in the nonhypothyroid group. Patients with hypothyroidism (both clinical and subclinical) had significantly lower serum albumin and serum calcium levels than those in the nonhypothyroid group. Intact parathyroid hormone was also significantly higher in the hypothyroid groups. An increased prevalence of hypothyroidism was observed in patients with a reduction in the glomerular filtration rate. Conclusion: There is growing evidence of increased prevalence of hypothyroidism in dialysis-independent CKD patients. A number of findings such as lower serum albumin, serum calcium, and hemoglobin levels and higher intact parathyroid hormone levels are seen in this group. Specific treatment can help improve these. Hence, there is a need to formulate guidelines to screen this population for hypothyroidism.

폐경후 여성의 무증상 갑상선 기능저하증과 골밀도 및 골대사지표와의 관련성

김창오,박계선,박경채,신경균,김문종,이영진 대한가정의학회 2008 Korean Journal of Family Medicine Vol.29 No.1

The Relationship of Subclinical Hypothyroidism with Bone Mineral Density and Biochemical Bone Markers in Postmenopausal WomenChang O Kim, M.D., Kye Seon Park, M.D., Kyung Chae Park, M.D., Kyung Kyun Shin, M.D., Moon Jong Kim, M.D., Young Jin Lee, M.D. Background: It is well recognized that thyroid hormone stimulates bone turnover, increasing bone resorption, thus affecting bone mineral density, but few data are available on untreated subclinical hypothyroidism. The aim of this study was to examine whether bone mineral density is increased in postmenopausal subclinical hypothyroidism patients compared with postmenopausal normal thyroid function women, and to evaluate the relationship between thyroid hormones (TSH, FT4) and bone mineral density or various biochemical markers of bone metabolism. Methods: This was a cross sectional study of 132 postmenopausal women aged from 51 to 70 who undertook health screening program in Pundang CHA general hospital from 1996 to 2001. They were divided into two groups; subclinical hypothyroidism group (n=52) and normal thyroid function group (n=80) matched by age. Results: The total bone mineral density was significantly increased in the subclinical hypothyroid group than in the normal group (P<0.05). The serum osteocalcin was lower in the subclinical hypothyroidism group (P<0.05), but neither the alkaline phosphatase nor the deoxypyridinoline showed any significance. For all participants in this study, TSH, but not FT4, exhibited significant correlation with the total bone mineral density (r=0.188, P<0.05), and with the osteocalcin (r=0.191, P<0.05). Multiple regression analysis identified the TSH as an independent predictor of the total bone mineral density (β=0.0410; P< 0.05). Conclusion: This study indicated that subclinical hypothyroidism is one of the factors which can elevate bone mineral density in postmenopausal women. (J Korean Acad Fam Med 2008;29:41-47) The Relationship of Subclinical Hypothyroidism with Bone Mineral Density and Biochemical Bone Markers in Postmenopausal WomenChang O Kim, M.D., Kye Seon Park, M.D., Kyung Chae Park, M.D., Kyung Kyun Shin, M.D., Moon Jong Kim, M.D., Young Jin Lee, M.D. Background: It is well recognized that thyroid hormone stimulates bone turnover, increasing bone resorption, thus affecting bone mineral density, but few data are available on untreated subclinical hypothyroidism. The aim of this study was to examine whether bone mineral density is increased in postmenopausal subclinical hypothyroidism patients compared with postmenopausal normal thyroid function women, and to evaluate the relationship between thyroid hormones (TSH, FT4) and bone mineral density or various biochemical markers of bone metabolism. Methods: This was a cross sectional study of 132 postmenopausal women aged from 51 to 70 who undertook health screening program in Pundang CHA general hospital from 1996 to 2001. They were divided into two groups; subclinical hypothyroidism group (n=52) and normal thyroid function group (n=80) matched by age. Results: The total bone mineral density was significantly increased in the subclinical hypothyroid group than in the normal group (P<0.05). The serum osteocalcin was lower in the subclinical hypothyroidism group (P<0.05), but neither the alkaline phosphatase nor the deoxypyridinoline showed any significance. For all participants in this study, TSH, but not FT4, exhibited significant correlation with the total bone mineral density (r=0.188, P<0.05), and with the osteocalcin (r=0.191, P<0.05). Multiple regression analysis identified the TSH as an independent predictor of the total bone mineral density (β=0.0410; P< 0.05). Conclusion: This study indicated that subclinical hypothyroidism is one of the factors which can elevate bone mineral density in postmenopausal women. (J Korean Acad Fam Med 2008;29:41-47)

갑상선기능저하증에 동반된 변비의 임상적 특징

김재일 ( Jaeil Kim ),명승재 ( Seung Jae Myung ),양동훈 ( Dong Hoon Yang ),윤인자 ( In Ja Yoon ),서소영 ( So Young Seo ),구현숙 ( Heun Sook Ku ),윤순만 ( Soon Man Yoon ),김경조 ( Kyung Jo Kim ),예병덕 ( Byong Duk Ye ),변정식 ( Jung 대한장연구학회 2010 Intestinal Research Vol.8 No.1

Background/Aims: Constipation is a well-recognized gastrointestinal symptom in patients with untreated hypothyroidism. Although thyroid function tests are recommended to exclude hypothyroidism in patients with constipation, there have been no reports to determine the causal relationship between thyroid function and constipation. The aim of this study was to determine the prevalence of hypothyroidism in constipated patients and the clinical features of constipation associated with hypothyroidism. Methods: A total of 1,481 constipated patients were included. These patients were divided into overt hypothyroidism, subclinical hypothyroidism, and normal thyroid function groups based on thyroid function tests. We reviewed the clinical presentation, anorectal function, colonic transit time, defecographic findings, and response to biofeedback therapy. Results: The prevalence of overt and subclinical hypothyroidism was 0.41% (men, 0.36%; women, 0.53%) and 1.76% (men, 1.28%; women 2.03%), respectively. There were no differences in total or segmental colonic transit times and subtypes of constipation among the normal thyroid function (n=54), overt hypothyroidism (n=4), and subclinical hypothyroidism groups (n=21). On anorectal manometry, the prevalence of dyssynergic defecation did not differ between the three groups. Rectal hyposensitivity was more frequent in the overt hypothyroidism group (overt hypothyroidism group, 50.0%; subclinical hypothyroidism group, 19.0%; normal thyroid function group, 20.4%) without statistical significance (P=0.372). Conclusions: The prevalence of overt and subclinical hypothyroidism in constipated patients was very low. The colonic transit time is not affected by thyroid function. (Intest Res 2010;8:48-57)

불현성 갑상선기능저하증 환자의 우울에 대한 체계적 문헌고찰및 메타분석

황은희,신수진 대한임상건강증진학회 2018 Korean Journal of Health Promotion Vol.18 No.1

Background: Symptoms of subclinical hypothyroidism include depression, memory loss, myocardial contractility disorder, lipid metabolic disorder, and atherosclerosis. However, the relationship between subclinical hypothyroidism and depression has not been consistent. Therefore, the purpose of this study was to provide the scientific evidence for the relationship between subclinical hypothyroidism and depression. Methods: This study was a meta-analysis of depression in subjects with subclinical hypothyroidism. The search engine of PubMed, EBSCO, ScienceDirect, and RISS was used to search the studies published since the 1990s. A total of 176 documents were retrieved from the literature search, and finally 10 studies were included in the analysis. Statistical analysis of effect sizes was performed using Comprehensive Meta-Analysis software version 2.2.064. Results: Of the 10 studies, five studies reported that depression was associated with subclinical hypothyroidism. Two of these studies were on women and two were on the elderly. The effect size of depression in patients with subclinical hypothyroidism was 3.46 (95% confidence interval 0.20-0.74, P=0.001), and the subclinical hypothyroidism was significantly associated with depression. Conclusions:This study showed that subclinical hypothyroidism is associated with depression. The results also suggest the need for regular screening of depressive symptoms of patients with subclinical hypothyroidism. Especially, elderly and women with subclinical hypothyroidism may be the main targets of depressive symptom 연구배경: 불현성 갑상선기능저하증의 증상으로는 우울증, 기억력 감소, 심근수축력 장애, 지질대사 장애, 동맥경화증 등이 알려져 있다. 그러나 불현성 갑상선기능저하증과 우울의 관계에 있어서는 일관된 결과가 제시되지 않고있다. 이에 본 연구에서는 불현성 갑상선기능저하증과 우울의 관련성에 대한 체계적 문헌고찰과 메타분석을 통해과학적 근거를 제시하는 것이다. 방법: 본 연구는 불현성 갑상선기능저하증 대상자의 우울에 대한 메타분석연구이다. 문헌검색을 위해서는 PubMed, EBSCO, ScienceDirect, 한국교육학술정보원(RISS)의 검색엔진을 이용하였고, 검색대상 연구는 1990년대 이후 발표된연구논문이었다. 문헌검색 결과 총 147개의 문헌이 검색되었으며, 최종적으로 분석에 포함된 연구는 10편이었다. 효과 크기의 통계적 분석은 Comprehensive Meta- Analysis software version 2.2.064를 이용하였다. 결과: 전체 10편의 연구 중 불현성 갑상선기능저하증과우울의 관련성이 있다고 보고한 연구가 5편이었으며, 이연구 중 여성을 대상으로 한 연구가 2편, 노인을 대상으로한 연구가 2편이었다. 불현성 갑상선기능저하증 환자의 우울의 효과 크기를 분석한 결과 효과 크기가 3.46 (95% CI 0.20-0.74, P=0.001)으로 불현성 갑상선기능저하증은 우울과 유의한 관계가 있는 것으로 나타났다. 결론: 본 연구는 불현성 갑상선기능저하증과 우울과의관련성에 대해 서로 상반된 연구 결과들이 보고되고 있는현 상황에서, 불현성 갑상선기능저하증과 우울의 관련성에대한 체계적인 근거를 제시하였다는 것에 의의가 있다. 또한 연구 결과는 불현성 갑상선기능저하증 환자의 정규적인우울 선별검사의 필요성을 제시하고 있으며, 특히 불현성갑상선기능저하증이 있는 노인과 여성이 우울 증상관리의주요 대상이 될 수 있을 것이다.

Changes of antithroglobulin antibody in children with congenital hypothyroidism

조은미,김욱현,최병호,고철우 대한소아내분비학회 2013 Annals of Pediatirc Endocrinology & Metabolism Vol.18 No.4

Purpose: It has been reported that antithroglobulin (anti-TG) antibody is increased in the sera of both children with transient congenital hypothyroidism and their mothers. And transplacental transport of thyroid autoantibody was proposed as the pathogenesis of transient congenital hypothyroidism. However this is not known in nontransient congenital hypothyroidism. This study was done to see changes of anti-TG antibody in children with nontransient congenital hypothyroidism. Methods: Study patients consisted of 60 patients diagnosed as congenital hypothyroidism in the Department of Pediatrics, Kyungpook National University Children’s Hospital, Daegu, Republic of Korea between January 2010 and March 2013. Healthy control were 45 children showing normal thyroid function. Anti-TG antibody and various laboratory tests were analyzed retrospectively, and compared in both children with congenital hypothyroidism and controls. Results: Anti-TG antibody was significantly higher in children with congenital hypothyroidism compared to healthy controls, 119.4±34.7 U/mL versus 80.6±19.6 U/mL, respectively (P <0.001). There was no significant difference of anti-TG antibody in gender and age. Conclusion: We observed a significant increase of anti-TG antibody in children with nontransient congenital hypothyroidism compared to healthy controls. Further study focusing pathogenetic role of anti-TG antibody in nontransient congenital hypothyroidism is necessary. Furthermore, the clinical significance in the course of congenital hypothyroidism need to be known.

Treadmill exercise increases central 5-hydroxytryptamine synthesis and tryptophan hydroxylase expression and reduces depressive-like symptom in methimazole-induced hypothyroidism rat pups

( Baek Vin Lim ),( Tae Soo Kim ),( Mal Soon Shin ) 한국운동영양학회 2013 Journal of exercise nutrition & biochemistry Vol.17 No.3

Depression is one of the most common psychiatric symptoms in hypothyroidism. Depression following hypothyroidism is closely associated with reduced activity of the serotonergic system. Physical exercise has positive effects for mental diseases such as depression. In the present study, we investigated the effects of treadmill exercise on the depressive-like symptom, 5-hydroxytryptamine (5-HT)and tryptophan hydroxylase (TPH) expression in the dorsal raphe nucleus of the rat pups with hypothyroidism. On the day of perinatal 14, pregnant rats were divided into two groups (n = 5 in each group): the pregnant control group and the pregnant methimazole (MMI)-treated group. For the induction of hypothyroidism in the rat pups, MMI was added to the drinking water, from the day of perinatal 14 to postnatal 49. After delivery, male rat pups born from the pregnant control group were assigned to the control group. Male rat pups born from the MMI-treated group were divided into the hypothyroidism-induction (HI) group and the hypothyroidism-induction with treadmill exercise (HIT) group (n = 10 in each group). The rat pups in the exercise group were forced to run on a treadmill for 30 min once a day for 4 weeks, starting on postnatal day 22. In the hypothyroidism-induced rat pups,5-HT synthesis and TPH expression was reduced in the dorsal raphe nucleus. Treadmill exercise alleviated hypothyroidism-induced depressive state by enhancing serotonergic related genes. These results suggest that treadmill exercise can be used as a therapeutic agent for hypothyroidism patients with depression.

내분비 ; 한국인에서 sunitinib 치료 후 발생한 갑상선기능저하의 특성

안화영 ( Hwa Young Ahn ),이은경 ( Eun Kyung Lee ),최훈성 ( Hoon Sung Choi ),이은정 ( Eun Jung Lee ),이유진 ( You Jin Lee ),김경원 ( Kyung Won Kim ),이세훈 ( Se Hoon Lee ),임석아 ( Seock Ah Im ),박영주 ( Young Joo Park ),박도준 ( D 대한내과학회 2009 대한내과학회지 Vol.76 No.1

목적: Sunitinib 치료 후 발생하는 갑상선기능저하증은 흔한 부작용이다. 발병 기전으로 sunitinib에 의한 파괴성 갑상선염, 갑상선으로의 요오드 운반 억제, 갑상선호르몬 합성과정의 억제 등이 제시되었다. 이는 요오드 섭취 정도에 따라서도 sunitinib에 의한 갑상선기능이상의 발생률이나 임상적 특성이 다를 수 있음을 시사한다. 이에 본 연구에서는 요오드 풍부 지역의 하나인 한국인에서 sunitinib 투여로 인한 갑상선기능저하증의 발생률 및 특성에 대해 조사해 보고자 하였다. 방법: 2005년 11월부터 2007년 7월까지 서울대학교병원에서 sunitinib을 투약했던 환자 중 sunitinib 치료 기간 혹은 후에 갑상선호르몬을 측정한 환자 25명을 대상으로 하였다. 13명은 sunitinib 투여 기간 혹은 후에 갑상선기능저하증을 의심할 수 있는 임상상을 보여 갑상선호르몬을 측정하였고, 12명은 임상상에 관계없이 추적관찰 위해 sunitinib 치료 기간 동안 갑상선호르몬을 측정하였다. 결과: 갑상선기능저하증을 의심할 수 있는 임상상을 보여 갑상선호르몬을 측정한 13명에서는 모두 갑상선기능저하증 소견을 보였으며(현성 9명, 무증상 4명), 임상상에 관계없이 sunitinib 투여 기간 중 갑상선호르몬을 측정한 12명에서는 6명이 갑상선기능저하증 소견을 보였고(현성 2명, 무증상 4명), 2명이 갑상선중독증 소견을 보였다. 19명의 갑상선기능저하증 환자들을 현성과 무증상 갑상선기능저하증으로 나누어 비교해 본 결과 갑상선자극호르몬 상승이 발견된 시기가 현성 갑상선기능저하증 환자들에서 유의하게 늦게 나타났고(44.5 대. 14.8주, p<0.05), sunitinib 누적 투여량은 유의하게 높게 나타났다(8050±3211 대. 3718±1961 mg, p<0.05). 19명의 환자에서 갑상선자극호르몬 수치와 갑상선자극호르몬 상승시까지의 sunitinib 투여 기간 및 투여 누적량 사이에는 상관성이 있는 것으로 나타났다. 결론: Sunitinib 투여 후 갑상선기능저하증의 발생률은 50% 이상일 것으로 예상되었으며, 다른 지역에서 시행된 연구와 비교해 볼 때 요오드 섭취 정도가 sunitinib에 의한 갑상선기능저하증 발병에 영향을 준다고 말하기는 어려운 결과를 보였다. 갑상선 기능저하증 정도는 sunitinib 투여기간 및 용량에 비례하였다. 향후 전향적 연구를 통해 정확한 발생률 및 요오드 섭취에 의한 영향을 평가해 보는 것이 필요하겠다. Background/Aims: Hypothyroidism is a common side effect induced by sunitinib. Studies have suggested that sunitinib induces destructive thyroiditis or inhibits iodine uptake by the thyroid or anti-thyroid peroxidase activity. Therefore, the amount of iodine intake will also influence the incidence and clinical characteristics of hypothyroidism after sunitinib treatment. We evaluated the incidence and clinical characteristics of hypothyroidism after sunitinib treatment in Korea, an area where iodine is abundant. Methods: Between November 2005 and July 2007, 25 patients who had thyroid hormone levels measured during or after sunitinib treatment were included. Of the 25 patients, 13 had thyroid function tests (TFT) because they had symptoms suggesting hypothyroidism and 12 underwent TFT independent of symptoms for screening. Results: All 13 patients who had symptoms suggesting hypothyroidism were hypothyroid (9 overt, 4 subclinical), 6 of 12 patients who had TFT independent of symptoms were hypothyroid (2 overt, 4 subclinical), and two had thyrotoxicosis. Of the 19 hypothyroid patients, the 11 overt hypothyroid patients took longer for a diagnosis of TSH elevation (44.5 vs. 14.8 weeks, p<0.05) and had a greater cumulative sunitinib dose (8050±3211 vs. 3718±1961 mg, p<0.05) compared with the subclinically hypothyroid patients. At the point of detecting TSH elevation, the TSH level correlated with the period and cumulative dose of sunitinib. Conclusions: The anticipated incidence of sunitinib-induced hypothyroidism is more than 50%. Compared with previous studies performed in other areas, the iodine intake did not affect the incidence of sunitinib-induced hypothyroidism. (Korean J Med 76:37-43, 2009)

Long working hours and risk of hypothyroidism in healthy workers: a cohort study

Lee Yesung,Lee Woncheol,김형렬 한국역학회 2022 Epidemiology and Health Vol.44 No.-

OBJECTIVES: Long working hours have been reported to cause various health problems. However, long working hours are currently practiced in many countries. To confirm the consistency with a previous study, the authors aimed to elucidate the causal relationship between long working hours and hypothyroidism through a longitudinal study. METHODS: Data was collected at baseline from 45,259 participants without thyroid disease and with no change in groups of weekly working hours, which were categorized into 36–40, 41–52, 53–60, and > 60 hours, during follow-up period. Hypothyroidism was defined using the reference limits of serum thyroid-stimulating hormone and free thyroxine levels. By estimating hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards regression analyses, the risk of incident hypothyroidism was evaluated with weekly working 36–40 hours as the reference. RESULTS: During 138,261.7 person-years of follow-up, 2,914 participants developed hypothyroidism (incidence density, 2.11 per 102 person-years). Multivariable-adjusted HRs of incident hypothyroidism for weekly working 41–52, 53–60, and > 60 hours compared with the reference group were 1.13 (95% CI 1.03–1.24), 2.53 (95% CI, 2.17–2.95), and 2.57 (95% CI, 2.09– 3.15), respectively. In dose-response analyses, long working hours had an approximately linear relationship with the incidence of hypothyroidism. The risk of incident hypothyroidism in weekly working 53–60 and > 60 hours compared with the reference group were significantly higher among the older age group (≥ 36 years, stratified by median age), men, and daytime workers. CONCLUSIONS: This large-scale cohort study demonstrated the association between long working hours and the increased risk of incident hypothyroidism with a dose-response relationship.

준임상적 갑상선기능저하증: 논란이 되는 주제들

박지훈 ( Ji Hun Park ),김호준 ( Ho Jun Kim ),이명종 ( Myeong Jong Lee ) 한방비만학회 2006 한방비만학회지 Vol.6 No.2

Subclinical hypothyroidism is defined as a normal serum free thyroxine level combined with an elevated thyroid stimulating hormone level. The causes of subclinical hypothyroidism are the same as those of overt hypothyroidism. There is good evidence that subclinical hypothyroidism is associated with progression to overt disease. The management of subclinical hypothyroidism is remains controversial. Patients with a serum thyroid stimulating hormone level greater than 10 mU/L have a higher incidence of elevated serum low-density lipoprotein cholesterol concentrations; however, evidence is lacking for other associations. There is insufficient evidence that hormone treatment of subclinical hypothyroidism is beneficial. The use of thyroid stimulating hormone level lone as a diagnostic and assessment tool for hypothyroidism is inadequate because this test cannot identify numerous conditions this sentence is unclear in its meaning. Using an expanded list of clinical signs and symptoms associated with dysfunction of the Hypothalamus-Pituitary-Thyroid axis, it is possible to hypothesize that subclinical hypothyroidism may be more common in a population of patients with early signs of age-related diseases than most practitioners realize. To improve thyroid function in subclinical hypothyroidism patients, practitioners should become familiar with foods and nutrients that can hinder or support thyroid function.