甲状腺功能和认知健康:重新思考"低于最佳"TSH/FT4水平和认知衰退之间的关系
Dvir Dori1,2,3,4, Bruna Seixas-Lima1,2, Carlos Roncero1
1Baycrest Academy for Research and Education/Rotman Research Institute, Toronto, Ontario, Canada.
Alzheimer's & dementia : the journal of the Alzheimer's Association
|December 16, 2025
概括
甲状腺功能低于最佳,由高正常甲状腺刺激激素 (TSH) 或低正常自由甲状腺素 (FT4) 定义,与老年人认知能力下降或痴呆症无关. 这些发现并不支持甲状腺补充剂用于认知健康.
科学领域:
- 内分泌学 在内分泌学.
- 神经学 神经学
- 老年病的医生 老年病的医生
背景情况:
- 有争议的假设表明,低于最佳的甲状腺功能可能会增加痴呆风险.
- 甲状腺功能低于最佳的定义是高于正常的TSH (2.0-4.5μIU/mL) 或低于正常的FT4.
研究的目的:
- 为了研究甲状腺功能不足和老年人认知障碍之间的关联.
- 评估那些将甲状腺功能与认知能力下降联系在一起的说法的有效性.
主要方法:
- 来自加拿大神经退行和痴呆症综合评估队列 (年龄在50-91岁) 的数据分析.
- 甲状腺功能被归类为最佳 (TSH < 2.0 μIU/mL或FT4 ≥ 16.74 pmol/L) 或亚最佳.
- 包括688名参与者的TSH数据和476名参与者的FT4数据.
主要成果:
- 甲状腺功能 (TSH或FT4) 和认知障碍之间没有发现显著的关联.
- 真正的甲状腺功能低下症很少见,高TSH的参与者中有98.6%的FT4水平正常.
- 基平方分析给出了TSH (p=0.67) 和FT4 (p=0.96) 的非显著的p值.
结论:
- 研究结果不支持高正常TSH或低正常FT4导致认知障碍的假设.
- 建议谨慎使用未经证实的甲状腺补充剂来改善认知健康.
- 对重新定义TSH切断值的临床理由受到质疑,挑战功能医学方法.
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