fa میزان بروز اختلال عملکرد و سیر طبیعی اختلال‌های زیربالینی تیروئید در بزرگسالان تهرانی پژوهشی Original <p class="Abstract" dir="rtl" style="MARGIN: 0cm 1cm 0pt TEXT-INDENT: 0cm LINE-HEIGHT: 17pt mso-line-height-rule: exactly"><strong><span lang="FA" style="FONT-SIZE: 13pt FONT-FAMILY: Lotus mso-ansi-language: AF">چکیده</span><span lang="FA" style="FONT-SIZE: 11pt FONT-FAMILY: Lotus mso-ansi-language: AF mso-ansi-font-size: 9.0pt"><p></p></span></strong></p><u><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut LETTER-SPACING: -0.1pt mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US">مقدمه</span></u><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut LETTER-SPACING: -0.1pt mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US">: باوجود شیوع قابل توجه اختلال‌های عملکرد تیروئید، اپیدمیولوژی آن به درستی مشخص نیست. این مطالعه برای تعیین میزان بروز اختلال‌های عملکرد و سیر طبیعی اختلال‌های زیر بالینی تیروئید در جامعه‌ی شهر تهران انجام شد. <u>مواد و روش‌ها</u>: از افراد 20 ساله و بالاتر شرکت‌کننده در «مطالعه‌ی آینده‌‌نگر قند و لیپید تهران» که در شروع و نیز 7/6 سال بعد دارای نمونه‌ی خون کافی بودند، آزمایش‌های </span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" LETTER-SPACING: -0.1pt mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">TSH</span><span dir="rtl"></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut LETTER-SPACING: -0.1pt mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span> و آنتی‌بادی ضدتیروئید پر اکسیداز ( </span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" LETTER-SPACING: -0.1pt mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">TPO-Ab</span><span dir="rtl"></span><span dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span> <span lang="FA"><font face="Yagut" size="3">) به عمل آمد. از 808 نفر جمعیت مورد مطالعه که فاقد سابقه‌ی بیماری یا جراحی تیروئید </font></span></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">،</span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"> مصرف هورمون‌های تیروئید </span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">،</span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"> داروهای آنتی‌تیروئید، </span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">،</span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"> گواتر یا ندول و آنتی‌بادی ضد </span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">TPO</span><span dir="rtl"></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span> منفی بودند </span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">، </span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US">میانگین، میانه، صدک‌های 5/2، 5، 95 و 5/97 برای </span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">TSH</span><span dir="rtl"></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span> تعیین و براساس صدک‌های 5/2 و 5/97، دامنه‌ی طبیعی </span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">TSH</span><span dir="rtl"></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span> بین 8/5-4/0 میکروواحد بر میلی‌لیتر تعیین شد. در افراد دارای </span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">TSH</span><span dir="rtl"></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span> غیر طبیعی </span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">T3</span><span dir="rtl"></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span>، </span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">T4</span><span dir="rtl"></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span>، </span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">T3RU</span><span dir="rtl"></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span> انجام و </span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">FTI</span><span dir="rtl"></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span> محاسبه شد. <u>یافته‌ها</u>: در مرحله‌ی اول آزمون‌های تیروئید 1065 زن و 693 مرد، طبیعی بودند. 7/6 سال بعد میزان بروز برای هر هزار نفر برای کم‌کاری بالینی تیروئید 28/0 در زنان و 21/0 در مردان، و کم‌کاری زیر بالینی تیروئید 59/11 در زنان و 69/4 در مردان، پرکاری بالینی 4/1 در زنان و 21/0 در مردان، پرکاری زیر بالینی 72/5 در زنان و 62/3 در مردان بود. در این مدت، افزایش مثبت شدن آنتی‌بادی ضد </span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">TPO</span><span dir="rtl"></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span> از 9/15% به 7/17% در زنان معنی‌دار بود. (006/0</span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">P=</span><span dir="rtl"></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span>). در مرحله‌ی اول، 8 زن کم‌کاری زیر بالینی تیروئید داشتند که در پیگیری 5 نفر در همان وضعیت ماندند، یک نفر دارای کارکرد طبیعی تیروئید، یک نفر به کم‌کاری بالینی تیروئید مبتلا شد. یک نفر باقیمانده در حال مصرف لووتیروکسین و دچار پرکاری بالینی تیروئید بود. دو زن باپرکاری زیر بالینی تیروئید در مرحله‌ی اول بدون مصرف دارو در پیگیری طبیعی شدند. در مرحله‌ی اول، دو مرد کم‌کاری زیر بالینی داشتند که در پیگیری یک نفر در همان وضعیت ماند و یک نفر به کم‌کاری بالینی تیروئید مبتلا شد. <u>نتیجه‌گیری</u>: دامنه‌ی طبیعی </span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">TSH</span><span dir="rtl"></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span> در این جامعه‌ی تهرانی 8/5-4/0 میکروواحد در میلی‌لیتر بود و افزایش فراوانی آنتی‌بادی ضد </span><span style="FONT-SIZE: 10pt FONT-FAMILY: "Times New Roman" mso-ansi-language: EN-US mso-bidi-font-size: 11.0pt mso-fareast-font-family: SimSun mso-bidi-font-family: Yagut mso-bidi-language: FA mso-font-kerning: 16.0pt mso-fareast-language: EN-US">TPO</span><span dir="rtl"></span><span lang="FA" dir="rtl" style="FONT-SIZE: 11pt FONT-FAMILY: Yagut mso-ansi-language: EN-US mso-ansi-font-size: 10.0pt mso-fareast-font-family: SimSun mso-bidi-language: FA mso-ascii-font-family: 'Times New Roman' mso-hansi-font-family: 'Times New Roman' mso-font-kerning: 16.0pt mso-fareast-language: EN-US"><span dir="rtl"></span> مثبت در زنان دیده شد. بروز اختلال‌های زیر بالینی نسبت به اختلال‌های بالینی تیروئید بارزتر بود. </span> <p class="Abstract" style="MARGIN: 0cm 1cm 0pt DIRECTION: ltr unicode-bidi: embed TEXT-ALIGN: justify"><strong><font face="Arial">Abstract</font></strong></p><p class="Abstract" style="MARGIN: 0cm 1cm 0pt DIRECTION: ltr unicode-bidi: embed TEXT-ALIGN: justify"><strong><font face="Arial"><u>Introduction</u>: <span style="COLOR: black">The aim of this study was to determine the incidence of thyroid dysfunction and the natural course of subclinical thyroid disorders in the Tehranian community. <u>Materials and Methods</u>: All individuals ≥20 years, who participated during the first to third phases (6 years, 7 months), of the "<place w:st="on"><city w:st="on">Tehran</city></place> Lipid and Glucose Study" and provided the relevant data were included in this study. Both Tpo-Ab and TSH were measured. In 808 TPO-Ab negative individuals who were not taking any thyroid & anti-thyroid drugs and without a history of thyroid disease, thyroid surgery, goiter and thyroid nodules, mean, median, 2.5, 5, 95, 97.5 percentile TSH were determined. On the basis of 2.5 and 97.5 percentile, normal reference range for TSH was 0.4-5.8 μu/mL. In those, whose TSH fell outside the reference range, T3, T4, and T3 uptake were measured and FTI was calculated. <u>Results: </u>In the first stage, 1065 women and 693 men had normal thyroid tests. After 6.7 years the incidence of clinical hypothyroidism was 0.28 in 1000 women and 0. 21 in 1000 men, subclinical hypothyroidism was 11.59 in 1000 women and 4. 69 in 1000 men, clinical hyperthyroidism was 1.4 in 1000 women and 0.21 in </span>1000 men, subclinical hyperthyroidism was 5.72 in 1000 women and 3.62 in 1000 men. In this period, increasing positivity of TPO-Ab from 15.9 to 17.7% in women was significant. (P=0.006) In the first stage 8 women had subclinical hypothyroidism, 5 still did on follow-up, one was normal, and one was diagnosed with clinical hypothyroidism. The remaining one was hyperthyroid on levothyroxin. Two women with subclinical hyperthyroidism in the first stage were normal in follow-up, without any treatment. In the first stage 2 men had subclinical hypothyroidism, and in follow-up, one was same, while the other was diagnosed with clinical hypothyroidism<span style="COLOR: black">. <u>Conclusion</u>: <place w:st="on">Normal</place> range of TSH was 0.4-5.8 μu/mL in the Tehranian community. There was significant increase of the frequency of subclinical thyroid disorders in both genders and frequency of clinical hyperthyroidism and TPO-Ab positive in women. Compared to clinical thyroid disorders, the incidence of subclinical thyroid disorders, was more significant. <p></p></span></font></strong></p> اختلال‌های زیربالینی تیروئید، پرکاری تیروئید، کم‌کاری تیروئید، بیماری‌های اتوایمیون تیروئید، میزان بروز، سیر طبیعی Subclinical thyroid disorders, Hyperthyroidism, Hypothyroidism autoimmune thyroid disorders, Incidence, Natural course 673 679 http://ijem.sbmu.ac.ir/browse.php?a_code=A-10-799-9&slc_lang=fa&sid=1 M Assadi مژگان اسدی 4000319475328460011367 4000319475328460011367 No H Delshad حسین دلشاد 4000319475328460011473 4000319475328460011473 No M Tohidi مریم توحیدی 4000319475328460011474 4000319475328460011474 No F Azizi فریدون عزیزی azizi@endocrine.ac.ir 4000319475328460011475 4000319475328460011475 Yes