Менопауза не влияет на функцию щитовидной железы: рост нарушений связан только со старением

TOPLINE A longitudinal study of healthy midlife women found that thyroid-stimulating hormone (TSH) levels rose gradually with age but showed no abrupt shift in level or slope at menopause, while free thyroxine (fT4) levels changed only modestly. The proportions of women with elevated TSH levels (> 4.5 mIU/L) and with hypothyroidism or hyperthyroidism also increased with age, with no distinct change at the menopausal transition. METHODOLOGY - Menopause may affect the hypothalamic-pituitary-thyroid axis but longitudinal data on thyroid changes across the menopausal transition independent of aging have been lacking. - Researchers conducted a longitudinal cohort study (2004-2024) using data from an annual health checkup program at a hospital in Tokyo to examine changes in thyroid function across the menopausal transition beyond the effects of aging in healthy women. - They included 7644 healthy women who experienced natural menopause and had at least one health checkup both before and after menopause; women were excluded if menopause timing could not be determined or if they had received hormone replacement therapy, undergone surgical procedures associated with surgical menopause, or had missing thyroid hormone data. - Participants had a median of 11 visits over a median follow-up period of 13.7 years, totaling 86,967 visits; the median age at the first visit and the first visit post-menopause was 45 and 52 years, respectively. - The primary outcomes were serum TSH and fT4 levels measured at each visit; the secondary outcomes were high (> 4.5 mIU/L), very high (> 10.0 mIU/L), low (< 0.4 mIU/L), and very low (< 0.1 mIU/L) abnormal TSH level categories as well as self-reported thyroid disorders with or without medication use. TAKEAWAY - In unadjusted analyses, TSH levels increased by 0.014 mIU/L per year (95% CI, 0.010-0.019) during premenopause, with no significant change noted in slope post-menopause; after adjustment for covariates, the premenopausal rise was attenuated to nonsignificance, and no change was observed post-menopause. - fT4 levels decreased before menopause (unadjusted beta coefficient, -0.005 ng/dL per year; 95% CI, -0.006 to -0.005) and stabilized thereafter, with an additional change in slope of +0.005 ng/dL per year (95% CI, 0.004-0.005) observed after menopause. Findings were similar in the adjusted analyses. - The proportion of women with high TSH levels (> 4.5 mIU/L) tended to increase with age, but no distinct changes in this trend were observed before and after menopause; other abnormal TSH thresholds (> 10, < 0.4, and < 0.1 mIU/L) remained low throughout the follow-up period and showed no distinct changes in trend at menopause. - The overall prevalence of hypothyroidism and hyperthyroidism tended to increase with age, but neither showed a distinct shift in trend at the menopausal transition; the proportion of women receiving medication for hyperthyroidism remained stable. IN PRACTICE "[The study] findings suggest that the increased risk of thyroid dysfunction is primarily attributable to the aging process rather than the menopausal transition. Clinical attention should be focused on the age-related progression of thyroid abnormalities, independent of menopausal status," the authors of the study wrote. SOURCE This study was led by Seiko Hayashi, St Luke's International Hospital, and Sho Fukui, MD, MPH, Kyorin University School of Medicine, both from Tokyo, Japan. It was published online in The Journal of Clinical Endocrinology & Metabolism. LIMITATIONS The timing of menopause was based on self-reported questionnaire data that contained no information on female hormones. Diagnoses of hypothyroidism and hyperthyroidism were self-reported, and data on free triiodothyronine levels, specific disease types, and specific thyroid autoantibodies were unavailable. Additionally, the study could not account for some factors such as dietary iodine intake. DISCLOSURES The study received no specific funding. One author reported receiving grants from the Japan Society for the Promotion of Science, Japan Science and Technology Agency, and Japan Agency for Medical Research and Development as well as consulting and speaking fees from various pharmaceutical companies or organizations outside of this work. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.