여성에서 갑상샘 기능과 심혈관계 질환의 위험인자와의 관계
The Relationship between Thyroid Function and the Risk Factors of Cardiovascular Disease at Female Medical Checkups
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배경 : 갑상샘호르몬은 지질대사와 당 대사에 중요한 역할을 하고 있으며, 무증상 갑상샘기능저하증에서 혈중 지질이상과 관 련이 있다는 보고와, 관련이 없다는 보고가 혼재되어있다. 그러 므로 무증상 갑상샘기능이상에서 갑상샘호르몬(FT4) 또는 갑상 샘자극호르몬(thyroid-stimulating hormone, TSH)과 심혈 관계질환 위험요소 및 대사증후군과의 연관성을 알아보고자 하 였다. 방법 : 여성 건강검진자중에서 정상갑상샘기능군(4,410명), 무증상 갑상샘기능저하증군(438명), 무증상 갑상샘기능항진증 군(66명) 사이의 연령, 혈압, 체질량지수, 공복혈당, 총콜레스테 롤, HDL콜레스테롤, LDL콜레스테롤, 중성지방, 리포지단백(a) 과 고감도 C-반응성 단백질을 비교하였고, FT4 또는 TSH와 심 혈관계질환의 위험요소 및 대사증후군과의 연관성을 알아보았다. 결과 : 공복혈당은 무증상 갑상샘기능항진증군에서 정상갑상 샘기능군이나 무증상 갑상샘기능저하증군과 비교해서 더 높았 고(P=0.031), 총콜레스테롤은 무증상 갑상샘기능저하증군에서 무증상 갑상샘기능항진증과 비교해서 의의있게 더 높았다(P= 0.011). 그러나 연령, 체질량지수, 혈압, HDL콜레스테롤, LDL 콜레스테롤, 중성지방, Lp(a), hsCRP는 세 군 사이에 차이가 없었다. TSH는 중성지방이 높은 경우에 더 높았고, FT4는 체 질량지수가 높을수록, 공복혈당이 정상인 경우보다는 126 mg/ dL 이상인 경우에, 중성지방이 높을수록 더 낮았다. TSH와 대 사증후군 발생과는 연관성이 없었으나, FT4 정상범위의 가장 낮은 사분위인 경우에 가장 높은 사분위에 비해 대사증후군 발 생의 위험이 1.3배 더 높았다. 결론 : FT4 검사 결과 해석 시 정상범위를 사분위로 세분화 할 필요가 있으며, 이는 대사증후군 발생을 예견하고 예방하는 데 도움이 될 수 있으리라 생각되었다.
Abstract
Background : Thyroid hormones play an important role in regulating lipid and glucose metabolism. Thus this study was conducted to investigate the relationship between the thyroid hormone (FT4) or thyroid stimulating hormone (TSH) and the cardiovascular risk factors and metabolic syndrome in the individuals with subclinical thyroid dysfunction. Methods : The female health examinee with normal range of FT4 were classified into three groups according to the level of TSH; euthyroid group (n=4,410), subclinical hypothyroidism group (n=438) and subclinical hyperthyroidism group (n=66). Age, blood pressure, BMI, fasting glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, lipoprotein(a), and high-sensitivity C-reactive protein (hsCRP) levels of serum specimens were compared among the groups and association of FT4 or TSH with these parameters. Results : Fasting glucose was significantly higher in subclinical hyperthyroidism than in euthyroid and subclinical hypothyroidism groups (P=0.031), and total cholesterol was higher in subclinical hypothyroidism than in subclinical hyperthyroidism (P=0.011). But the other factors showed no difference among the groups. The level of TSH increased as triglyceride increased, while FT4 decreased as BMI or triglyceride increased. The FT4 also lowered when fasting glucose was above 126 mg/dL. TSH was not related with the metabolic syndrome, but the possibility of the syndrome was 1.3 times higher in the lowest quartile of the normal range of FT4 than in its highest quartile. Conclusions : For the interpretation of FT4, its reference interval needs to be divided into 4 quartiles, which can be used as one of the predicting factors of the metabolic syndrome.
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