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Abstract：
OBJECTIVE: Thyroid disorders have been reported in hypercortisolism patients. Endogenous Cushing\'s syndrome (CS) potentially complicates its metabolic sequelae. We investigated thyroid function in CS patients to determine this relationship.
METHODS: In this cross-sectional study, we screened CS patients from 2016 to 2019 at our hospital. Patient demographic, medical history, and laboratory data were collected. Additionally, we performed a meta-analysis to demonstrate the prevalence of thyroid dysfunction in patients with CS.
RESULTS: Among 129 CS patients, 48.6% had triiodothyronine (TT3), 27.9% had thyroxine (TT4), 24.6% had free T3 (FT3), 27.7% had free T4 (FT4), and 6.2% had thyroid-stimulating hormone (TSH) levels below the reference values. Those with clinical CS showed more pronounced thyroid suppression than did those with subclinical CS. Cortisol levels were markedly greater in patients with pituitary hypothyroidism (P < 0.001). Serum cortisol levels throughout the day and post low-dose dexamethasone-suppression test (LDDST) results correlated with thyroid hormone levels, particularly in ACTH-independent CS. Correlations varied by thyroid status; FT3 and TSH were linked to cortisol in euthyroid individuals but not in those with low T3 or central hypothyroidism. TSH levels notably halved from the lowest to highest cortisol tertile post-LDDST. Finally, meta-analysis showed 22.7% (95% CI 12.6%-32.9%) central hypothyroidism in 528 CS patients of nine studies.
CONCLUSIONS: Thyroid hormone levels are significantly correlated with cortisol levels and are impaired in patients with CS. However, the physiological adaptation and pathological conditions need further study.
METHODS: In this cross-sectional study, we screened CS patients from 2016 to 2019 at our hospital. Patient demographic, medical history, and laboratory data were collected. Additionally, we performed a meta-analysis to demonstrate the prevalence of thyroid dysfunction in patients with CS.
RESULTS: Among 129 CS patients, 48.6% had triiodothyronine (TT3), 27.9% had thyroxine (TT4), 24.6% had free T3 (FT3), 27.7% had free T4 (FT4), and 6.2% had thyroid-stimulating hormone (TSH) levels below the reference values. Those with clinical CS showed more pronounced thyroid suppression than did those with subclinical CS. Cortisol levels were markedly greater in patients with pituitary hypothyroidism (P < 0.001). Serum cortisol levels throughout the day and post low-dose dexamethasone-suppression test (LDDST) results correlated with thyroid hormone levels, particularly in ACTH-independent CS. Correlations varied by thyroid status; FT3 and TSH were linked to cortisol in euthyroid individuals but not in those with low T3 or central hypothyroidism. TSH levels notably halved from the lowest to highest cortisol tertile post-LDDST. Finally, meta-analysis showed 22.7% (95% CI 12.6%-32.9%) central hypothyroidism in 528 CS patients of nine studies.
CONCLUSIONS: Thyroid hormone levels are significantly correlated with cortisol levels and are impaired in patients with CS. However, the physiological adaptation and pathological conditions need further study.
摘要：
目的：已经报道了皮质醇增多症患者的甲状腺疾病。内源性库欣综合征（CS）可能使其代谢后遗症复杂化。我们调查了CS患者的甲状腺功能以确定这种关系。
方法：在这项横断面研究中，我们在我们医院筛查了2016年至2019年的CS患者。患者人口统计，病史,并收集了实验室数据。此外,我们进行了一项荟萃分析,以证明CS患者甲状腺功能异常的患病率.
结果：在129例CS患者中，48.6%有三碘甲状腺原氨酸（TT3），27.9%有甲状腺素(TT4),24.6%有游离T3（FT3），27.7％的人有游离T4（FT4），6.2%的促甲状腺激素(TSH)水平低于参考值.临床CS患者比亚临床CS患者表现出更明显的甲状腺抑制。垂体甲状腺功能减退症患者的皮质醇水平明显升高（P<0.001）。全天血清皮质醇水平和低剂量地塞米松抑制试验（LDDST）结果与甲状腺激素水平相关，特别是在ACTH独立的CS。相关性因甲状腺状态而异；在甲状腺功能正常的个体中，FT3和TSH与皮质醇有关，但在低T3或中枢甲状腺功能减退症的个体中没有。TSH水平从LDDST后的最低到最高皮质醇三位数明显减少了一半。最后,荟萃分析显示，在9项研究的528例CS患者中，有22.7％（95％CI12.6％-32.9％）的中心性甲状腺功能减退。
结论：CS患者的甲状腺激素水平与皮质醇水平显著相关，并且受损。然而,生理适应和病理状况需要进一步研究。
方法：在这项横断面研究中，我们在我们医院筛查了2016年至2019年的CS患者。患者人口统计，病史,并收集了实验室数据。此外,我们进行了一项荟萃分析,以证明CS患者甲状腺功能异常的患病率.
结果：在129例CS患者中，48.6%有三碘甲状腺原氨酸（TT3），27.9%有甲状腺素(TT4),24.6%有游离T3（FT3），27.7％的人有游离T4（FT4），6.2%的促甲状腺激素(TSH)水平低于参考值.临床CS患者比亚临床CS患者表现出更明显的甲状腺抑制。垂体甲状腺功能减退症患者的皮质醇水平明显升高（P<0.001）。全天血清皮质醇水平和低剂量地塞米松抑制试验（LDDST）结果与甲状腺激素水平相关，特别是在ACTH独立的CS。相关性因甲状腺状态而异；在甲状腺功能正常的个体中，FT3和TSH与皮质醇有关，但在低T3或中枢甲状腺功能减退症的个体中没有。TSH水平从LDDST后的最低到最高皮质醇三位数明显减少了一半。最后,荟萃分析显示，在9项研究的528例CS患者中，有22.7％（95％CI12.6％-32.9％）的中心性甲状腺功能减退。
结论：CS患者的甲状腺激素水平与皮质醇水平显著相关，并且受损。然而,生理适应和病理状况需要进一步研究。
