ObjectiveTo systematically review the relationship between subclinical thyroid dysfunction and the risk of atrial fibrillation.MethodsDatabases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data were electronically searched to collect cohort studies on associations between subclinical thyroid dysfunction and atrial fibrillation from inception to June 2020. Two reviewers independently screened literature, extracted data, and evaluated risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 11 studies involving 620 874 subjects and 19 781 cases were included. Meta-analysis showed that subclinical hypothyroidism was not associated with atrial fibrillation (adjusted RR=1.20, 95%CI 0.92 to 1.57, P=0.18) and subclinical hyperthyroidism could increase the risk of atrial fibrillation (adjusted RR=1.65, 95%CI 1.12 to 2.43, P=0.01). Subgroup analysis showed that for the community population, subclinical hypothyroidism was not associated with atrial fibrillation (adjusted RR=1.03, 95%CI 0.84 to 1.26, P=0.81); for cardiac surgery, subclinical hypothyroidism could increase the risk of atrial fibrillation (adjusted RR=2.80, 95%CI 1.51 to 5.19, P=0.001); subclinical hyperthyroidism could increase the risk of atrial fibrillation among patients with TSH≤0.1 mlU/L (adjusted RR=2.06, 95%CI 1.07 to 3.99, P=0.03) and TSH=0.1～0.44 mlU/L (adjusted RR=1.29, 95%CI 1.01 to 1.64, P=0.04). ConclusionsSubclinical hypothyroidism is not associated with atrial fibrillation and subclinical hyperthyroidism can increase the risk of atrial fibrillation. Due to limited quantity and quality of included studies, more high quality studies are needed to verify above conclusions.
Atrial fibrillation is one of the most common arrhythmias, which can cause embolism, heart failure, cardiac arrest, and other cardiovascular deaths, causing a serious economic burden on patients. Scholars have begun to explore the relationship between atrial fibrillation and hypothyroidism, including clinical hypothyroidism, subclinical hypothyroidism, and threshold state of thyroid function, which means that thyroid stimulating hormone, free triiodothyronine, and free thyroxine are high or low in the normal range. This article reviews the occurrence and mechanism of hypothyroidism promoting atrial fibrillation, and aims to provide a basis for clinical intervention in patients with hypothyroidism to reduce the occurrence of atrial fibrillation.
目的:探讨甲状腺功能低下的早产儿血清游离三碘甲状腺原氨酸(Free trilute,FT3)、游离甲状腺激素(Free thyroxin,FT4)、促甲状腺激素(Thyroid stimulation hormone,TSH)水平进行动态态变化及临床意义。方法:我院在2007年11月至2008年4月住院的32例诊断为甲状腺功能低下的早产儿为研究对象,应用放射免疫法检测生后第1天,第7天,第15天,1月和2月血清FT3、FT4、TSH水平。结果:32例诊断为甲状腺功能低下的早产儿中,有窒息史的22例,呼吸窘迫综合症(Respiratory distress syndrome,RDS)10例,单纯性早产5例;出现少吃少动临床症状6例;生后各时期的TSH变化没有统计学差异,生后1、5天与生后1、2月FT3、FT4则可见Plt;0.05具有统计学差异。结论:有窒息和RDS的早产儿中,容易发生甲状腺功能降低,以低甲状腺素血症最为常见,使用左旋甲状腺素后,FT-3、FT-4水平可迅速恢复正常。如果同时存在TSH增高,则TSH水平恢复较慢。
目的 探讨甲状腺功能亢进症(甲亢)围手术期T3、T4水平的变化及其临床意义。方法 检测30例甲亢患者服碘及心得安作术前准备前(a)、术日晨(b)、术中(c)、术后第1天(d)及术后第5天(e)各时相点T3、T4水平。结果 全组患者均未发生甲状腺危象，T3、T4水平a＞b＞c＞d＞e，其中a、b、c高于正常值，d、e值在正常范围。结论 经术前准备，甲亢患者符合临床手术条件时，血T3、T4仍然高于正常水平； 手术未造成甲状腺激素大量释放； 术后12及36小时时段甲状腺危象高发期T3、T4水平不高。