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La función tiroidea y la mortalidad en pacientes tratados por hipertiroidismo.

Jayne A Franklyn1, Michael C Sheppard, Patrick Maisonneuve

  • 1Division of Medical Sciences, University of Birmingham, England.

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|July 7, 2005
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Resumen
Este resumen es generado por máquina.

El tratamiento con yodo radiactivo para el hipertiroidismo aumentó inicialmente la mortalidad, pero este riesgo disminuyó con la terapia con tiroxina (T4). Se recomienda el tratamiento del hipertiroidismo para inducir el hipotiroidismo y el posterior reemplazo de T4, especialmente si se desarrolla hipotiroidismo subclínico.

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Área de la Ciencia:

  • Endocrinología y Metabolismo.
  • Salud Cardiovascular La salud cardiovascular.
  • Epidemiología de la salud pública Epidemiología de la salud pública

Sus antecedentes:

  • El hipertiroidismo está relacionado con una elevada mortalidad por todas las causas y la mortalidad circulatoria.
  • La reversibilidad de este aumento de la mortalidad y el impacto de la disfunción tiroidea leve o el hipotiroidismo inducido por el tratamiento siguen sin estar claros.

Objetivo del estudio:

  • Para investigar la asociación entre el tratamiento con yodo radiactivo para el hipertiroidismo y la mortalidad.
  • Evaluar la influencia de la disfunción tiroidea leve y el hipotiroidismo tratados con tiroxina (T4) en los resultados de mortalidad.

Principales métodos:

  • Un estudio de cohorte basado en la población de 2668 individuos mayores de 40 años tratados por hipertiroidismo con yodo radioactivo (1984-2002).
  • Comparación de la mortalidad por causa específica con las tasas específicas por edad y período para Inglaterra y Gales.
  • Análisis del impacto de la terapia T4 en la mortalidad en el hipotiroidismo inducido por yodo radiactivo y la disfunción tiroidea subclínica.

Principales resultados:

  • La mortalidad global fue más alta (SMR 1.14) en el grupo tratado con yodo radiactivo en comparación con la población general.
  • Se observaron mayores riesgos de mortalidad antes o sin tratamiento con T4, pero no durante el tratamiento con T4.
  • La terapia T4 se asoció con una reducción significativa de todas las causas (HR 0.65) y la mortalidad circulatoria (HR 0.65).

Conclusiones:

  • El tratamiento con yodo radiactivo para el hipertiroidismo se asocia con un aumento de la mortalidad, que se mitiga con el posterior tratamiento con tiroxina (T4).
  • Se apoya la inducción de hipotiroidismo manifiesto con dosis suficientes de yodo radiactivo seguidas de reemplazo de T4.
  • El hipotiroidismo subclínico después de la terapia de yodo radioactivo puede aumentar la mortalidad por enfermedad cardíaca isquémica, lo que justifica la consideración de la sustitución de T4.