دﺰﻳ ﻲﻗوﺪﺻ ﺪﻴﻬﺷ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﻲﺸﻫوﮋﭘ ﻲﻤﻠﻋ ﻪﻠﺠﻣ
Journal of Shahid Sadoughi University of Medical Sciences
هرود 19 هرﺎﻤﺷ ، 2 ، ﺮﻴﺗ و دادﺮﺧ 1390
Vol. 19, No. 2, May-Jun 2011
ﻪﺤﻔﺻ : 156 - 148
Pages: 148-156
ﺰﻳﺮﺒﺗ ﺮﻬﺷ ﻦﺴﻣ يﺎﻫ ﻢﻧﺎﺧ رد ﺪﻴﺋوﺮﻴﺗ دﺮﻜﻠﻤﻋ لﻼﺘﺧا
ﺮﻓﺎﻴﻧ اﺮﺘﻴﻣ
1*
ﻲﻣاﺮﻬﺑ ﺮﻴﻣا ، ﻲﻠﻋ ﺮﺒﻛا ،2
هدازﺮﮕﺴﻋ
،3
ﻲﻣﻼﻏ ﻦﻳﺮﺴﻧ
4
3
، 1 - يﺎﻬﻳرﺎﻤﻴﺑ هوﺮﮔ رﺎﻴﺸﻧاد ﻢﺴﻴﻟﻮﺑﺎﺘﻣ و ﺰﻳر نورد دﺪﻏ ﺺﺼﺨﺗ قﻮﻓ ،ﻲﻠﺧاد
، هﺎﮕﺸﻧاد ﻲﻜﺷﺰﭘ مﻮﻠﻋ ﺰﻳﺮﺒﺗ
2 - د دﺪﻏ ﺺﺼﺨﺗ قﻮﻓ ،ﻲﻠﺧاد يﺎﻬﻳرﺎﻤﻴﺑ هوﺮﮔ دﺎﺘﺳا ﻢﺴﻴﻟﻮﺑﺎﺘﻣ و ﺰﻳر نور
، هﺎﮕﺸﻧاد ﻲﻜﺷﺰﭘ مﻮﻠﻋ ﺰﻳﺮﺒﺗ
4 -
،ﻲﻠﺧاد يﺎﻬﻳرﺎﻤﻴﺑ ﺖﻧﺪﻳزر ﺰﻳﺮﺒﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد
ﺖﻓﺎﻳرد ﺦﻳرﺎﺗ
: 13 / 2 / 1389 شﺮﻳﺬﭘ ﺦﻳرﺎﺗ
: 2 / 10 / 1389
هﺪﻴﻜﭼ
ﻪﻣﺪﻘﻣ
ﻲﻌﻄﻘﻣ ﻪﻌﻟﺎﻄﻣ ﻦﻳا فﺪﻫ:
، رد ﻖﻴﻘﺤﺗ درﻮﻣ
يﺪﻴﺋوﺮﻴﺗ تﻻﻼﺘﺧا عﻮﻴﺷ رد
نﺎﻧز يﻻﺎﺑ 60 لﺎﺳ ﺰﻳﺮﺒﺗ رد ﺮﻬﺷ ﻦﻳﺮﺘﮔرﺰﺑ ﻪﻛ
ﺖﺳا ناﺮﻳا بﺮﻏ لﺎﻤﺷ ﺪﺷﺎﺑ ﻲﻣ
.
شور ﻲﺳرﺮﺑ
رد :
ﺎﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳا هدﺎﻔﺘﺳا
زا تﺎﻋﻼﻃا ﺰﻛاﺮﻣ ﺘﺷاﺪﻬﺑ ﻲ ﺮﻬﺷ ﺮﺒﺗ ﻳ ﺰ و ﮔرﺎﻜﺑ ﻴ ﺮ ي شور ﻪﻧﻮﻤﻧ ﮔ ﻴ ﺮ ي ﻓدﺎﺼﺗ ﻲ
، ﻪﻧﻮﻤﻧ ﻚﻳ
1000 ﺑ يﺮﻔﻧ ﺎ ﻦﻴﺑ ﻦﺳ 89 - 60 ﺳ لﺎ ) ﻂﺳﻮﺘﻣ 4 / 5 5± / 64 ( بﺎﺨﺘﻧا ﺪﺷ و دﺮﻜﻠﻤﻋ يﺎﻫ ﺖﺴﺗ ﺪﻴﺋوﺮﻴﺗ
) ﻞﻣﺎﺷ وTSH
زآ ﺢﻄﺳ دا و T4
دازآ ﺢﻄﺳ (T3
داﺮﻓا ﻦﻳا رد مﺎﺠﻧا
ﺪﺷ . لﺎﻣوزوﺮﻜﻴﻣ ﻲﺘﻧآ يدﺎﺑ ﻲﺘﻧآ
رد ﻂﻘﻓ ﺢﻄﺳ ﻪﻛ يداﺮﻓا ﻻﺎﺑTSH
ﺪﻨﺘﺷاد يﺮﻴﮔ هزاﺪﻧا ﺪﺷ
.
ﻳﺎﺘﻧ ـ ﺞ
دﺎﺘﻔﻫ :
و ﻪﺳ ﺮﻔﻧ ) 3 / 7
% ( ﺢﻄﺳ ﻲﻣﺮﺳ TSH
ﻻﺎﺑ )
<
mIu/l
5 / 4 ( و 54 ﺮﻔﻧ ) 4 / 5
% ( ﺢﻄﺳ ناﺰﻴﻣ زا ﺮﺘﻤﻛ TSH
لﺎﻣﺮﻧ
>) mIu/l
3 / 0 ( ﺪﻨﺘﺷاد . ﺧا ﻲﻠﻛ عﻮﻴﺷ ﻪﻧﻮﻤﻧ ﻞﻛرد يﺪﻴﺋوﺮﻴﺗ تﻻﻼﺘ
7 / 12
% دﻮﺑ . عﻮﻴﺷ ﻢﺴﻳﺪﻴﺋوﺮﻴﺗﻮﭙﻴﻫ رﺎﻜﺷآ
و ﻲﻨﻴﻟﺎﺑ ﺖﺤﺗ ﻪﺑ
ﺐﻴﺗﺮﺗ 5 / 1
% و 8 / 5
% عﻮﻴﺷ و ﻢﺴﻳﺪﻴﺋوﺮﻴﺗﺮﭙﻳﺎﻫ
و رﺎﻜﺷآ ﺐﻴﺗﺮﺗ ﻪﺑ ﻲﻨﻴﻟﺎﺑ ﺖﺤﺗ 2
/ 1
% و 4 / 1
% دﻮﺑ . رد داﺮﻓا ﺎﺑ ﺢﻄﺳ
،ﻻﺎﺑ TSH
رد يدﺎﺑ ﻲﺘﻧآ لﺎﻣوزوﺮﻜﻴﻣ ﻲﺘﻧآ يﻻﺎﺑ يﺎﻫﺮﺘﻴﺗ 6
/ 60 % زا ﺑ نارﺎﻤﻴﺑ ﻪ ﺳد ﺪﻣآ ﺖ .
ﻪﺠﻴﺘﻧ يﺮﻴﮔ
ﺪﻴﺋوﺮﻴﺗ ﻲﻌﻴﺒﻃﺮﻴﻏ ﻲﻳﺎﻴﻤﻴﺷﻮﻴﺑ دﺮﻜﻠﻤﻋ عﻮﻴﺷ:
رد هﺪﺷ شراﺰﮔ ﻪﺟﻮﺗ ﻞﺑﺎﻗ ﻪﻌﻟﺎﻄﻣ ﻦﻳا
و هدﻮﺑ ﻲﻠﺒﻗ تﺎﻌﻟﺎﻄﻣ ﺞﻳﺎﺘﻧ رد
ﺮﮕﻳد يﺎﻫ ﺖﻴﻌﻤﺟ ار
ﻴﻳﺎﺗ ﺪ ﻤﻧ ﻲﻣ ﻳﺎ ﺪ . ﺎﻣ رد زا ﻲﻳﻻﺎﺑ عﻮﻴﺷ ﻪﻌﻟﺎﻄﻣ ﻦﻳا تﻻﻼﺘﺧا
ﺪﻴﺋوﺮﻴﺗ ار رد ﺖﻴﻌﻤﺟ نﺎﻧز ﻦﺴﻣ ﻲﻗﺮﺷ نﺎﺠﻳﺎﺑرذآ
ﺑ ﻪ ﻢﻳدروآ ﺖﺳد .
زا ﻞﺻﺎﺣ ﺞﻳﺎﺘﻧ ﺪﻧاﻮﺗ ﻲﻣ ﻪﻌﻟﺎﻄﻣ ﻦﻳا
ﻲﻣﻮﻤﻋ ﺖﺷاﺪﻬﺑ ﻪﻣﺎﻧﺮﺑ ﻦﻴﻴﻌﺗ ﺖﻬﺟ يا ﻪﻳﺎﭘ تﺎﻋﻼﻃا و
دﺎﺠﻳا ار تاﺮﻴﻴﻐﺗ
ﻢﻫاﺮﻓ ﺪﻳﺎﻤﻧ .
يﺎﻫ هژاو ﻴﻠﻛ ـ يﺪ
يدﺎﺑ ﻲﺘﻧآ لﺎﻣوزوﺮﻜﻴﻣ ﻲﺘﻧآ :
- ﺮﻴﺗﻮﭙﻳﺎﻫ يﺪﻴﺋو - يﺪﻴﺋوﺮﻴﺗﺮﭙﻳﺎﻫ -
ﻦﺴﻣ نﺎﻧز
)*
لﻮﺌﺴﻣ هﺪﻨﺴﻳﻮﻧ (
ﻦﻔﻠﺗ؛
: 3810105 - 0411
، ﻲﻜﻴﻧوﺮﺘﻜﻟا ﺖﺴﭘ :
نارﺎﻜﻤﻫ و ﺮﻓﺎﻴﻧ اﺮﺘﻴﻣ
149
ﻘﻣ ـ ﻪﻣﺪ ﺖﻓﺮﺸﻴﭘ يﺎﻫ شور ﻲﻫﺎﮕﺸﻳﺎﻣزآ
ﻲﺑﺎﻳزرا ياﺮﺑ دﺮﻜﻠﻤﻋ
ﺮﻴﺗ و ﺪﻴﺋو
هدﺎﻔﺘﺳا نوﺰﻓازور و زا هدﺮﺘﺴﮔ ﺮﺠﻨﻣ ﺎﻫ ﺖﺴﺗ ﻦﻳا
ﻞﺑﺎﻗ ﺶﻳاﺰﻓا ﻪﺑ
رد ﻪﺟﻮﺗ ﺖﺳا هﺪﺷ ﺪﻴﺋوﺮﻴﺗ ﻒﻴﻔﺧ تﻻﻼﺘﺧا ﺺﻴﺨﺸﺗ .
تﺎﻌﻟﺎﻄﻣ
رد ﻲﻠﺒﻗ يﺎﻬﻳرﺎﻤﻴﺑ عﻮﻴﺷ ﻲﺳرﺮﺑ ﺪﻴﺋوﺮﻴﺗ
رد و ناﺮﻳا ﺮﻳﺎﺳ ﺎﻫرﻮﺸﻛ
،
ﻲﻧارﺎﻤﻴﺑ زا ار ﻦﻴﻨﺳ ﻪﻤﻫ ﺪﺷ ﻲﻣ ﻞﻣﺎﺷ
و يدﺎﻀﺘﻣ ﺞﻳﺎﺘﻧ
ﺪﻨﺘﺷاد ) 8 - 1 (.
ﺎﻄﻣ ﻦﻳا ﺐﻠﻏا زا ﻲﻜﭼﻮﻛرﺎﻤﺷ ﻂﻘﻓ تﺎﻌﻟ
نارﺎﻤﻴﺑ
ار هدرﻮﺨﻟﺎﺳ هدادراﺮﻗ ﻲﺑﺎﻳزرا ﺖﺤﺗ
دﻮﺑ ﺪﻧ ﺑ ﻪ ﺖﻓﺮﺸﻴﭘ هوﻼﻋ يﺎﻫ
ﺮﻴﺧا رد تﻻﻼﺘﺧا ﻪﻛ ﺖﺳﺎﻨﻌﻣ ﻦﻳا ﻪﺑ يﺪﻴﺋوﺮﻴﺗ دﺮﻜﻠﻤﻋ يﺎﻫ ﺖﺴﺗ
ﺪﻧﻮﺷرﺎﻜﺷآ نﻮﻨﻛا ﺖﺳا ﻦﻜﻤﻣ ﻲﻠﺒﻗ هﺪﺸﻧ هداد ﺺﻴﺨﺸﺗ .
ﻲﻨﻴﻟﺎﺑ ﺖﺤﺗ ﻢﺴﻳﺪﻴﺋوﺮﻴﺗﻮﭙﻳﺎﻫ هﻮﻘﻟﺎﺑ ﺞﻳﺎﺘﻧ )
ناﺰﻴﻣ ﺮﺗﻻﺎﺑ TSH
زا ﻄﺳ لﺎﻣﺮﻧ ﺢ ﺎﺑ هاﺮﻤﻫ
FT4, FT3
لﺎﻣﺮﻧ ( ﺮﺘﻤﻛ ﻲﺳرﺮﺑ و هﺪﺷ ﻲﻟ
ًاﺮﻴﺧا دﺎﻬﻨﺸﻴﭘ ﻪﺘﻓﺎﻳ ﺶﻳاﺰﻓا ﺢﻄﺳ ﻪﻛ ﺖﺳا هﺪﺷ
رد TSH
ﺪﻧاﻮﺗ ﻲﻣ نﺎﮔدرﻮﺨﻟﺎﺳ ﻲﻳاﺰﺴﺑ ﺮﻴﺛﺎﺗ
رد و گﺮﻣ ناﺰﻴﻣ ﺮﻴﻣ
ﻪﺘﺷاد
ﺪﺷﺎﺑ ) 9 (
، رد ﺮﺘﺸﻴﺑ ﻣ ﻦﻳا ﻪﺑ تﻻﺎﻘ ﻲﺿراﻮﻋ
زا ﻪﻠﻤﺟ
و ﺲﻳزوﺮﻠﻜﺳاوﺮﺗآ و گﺮﻣ
ﺮﻴﻣ ﻲﻗوﺮﻋ ﻲﺒﻠﻗ )
10 (
، ﺶﻳاﺰﻓا رد
و لﺎﺗﻮﺗ لوﺮﺘﺴﻠﻛ لوﺮﺘﺴﻠﻛ LDL
) 11 (
، ﻢﻳﻼﻋ ﻲﺒﺼﻋ - ﻲﻧاور ) 12 (
و ﺖﻳﺎﻬﻧ رد د ﺖﻣﻼﻋ يﺪﻴﺋوﺮﻴﺗﻮﭙﻳﺎﻫ ﺖﻤﺳ ﻪﺑ ﺖﻓﺮﺸﻴﭘ
را هرﺎﺷا
ﺖﺳا هﺪﺷ )
13 (.
ﺮﻈﻧ ﻪﺑ ﺪﺳر ﻲﻣ يﺪﻴﺋوﺮﻴﺗﻮﭙﻳﺎﻫ ﺺﻴﺨﺸﺗ زا ﺲﭘ
ﺮﻫ ﻲﻨﻴﻟﺎﺑ ﺖﺤﺗ لﺎﺳ
رد دوﺪﺣ 4
% زا ﻦﻳا داﺮﻓا ﺖﻤﺳ ﻪﺑ
ﻮﭙﻳﺎﻫ رﺎﻜﺷآ يﺪﻴﺋوﺮﻴﺗ ﺪﻨﻨﻛ ﻲﻣ ﺖﻓﺮﺸﻴﭘ
) 14
، 13 (.
ﭙﻳﺎﻫ ﺮ يﺪﻴﺋوﺮﻴﺗ ﻲﻨﻴﻟﺎﺑ ﺖﺤﺗ
) ناﺰﻴﻣ لﺎﻣﺮﻧ ﺢﻄﺳ زا ﺮﺘﻤﻛ TSH
ﺎﺑ هاﺮﻤﻫ
FT4, FT3
لﺎﻣﺮﻧ ( ﺎﺑ ﺖﺳا ﻦﻜﻤﻣ ﻲﺒﻠﻗ يﺎﻫﺪﻣﺎﻴﭘ
ﺮﻀﻣ ) 15،16 ( از يﺰﻴﻠﻫد نﻮﻴﺳﻼﻳﺮﺒﻴﻓ ﻪﻠﻤﺟ )
17 (
، لﻼﺘﺧا
دﺮﻜﻠﻤﻋ ﻲﺒﻠﻗ
، و گﺮﻣ ناﺰﻴﻣ ﺶﻳاﺰﻓا ﺮﻴﻣ
) 18 (
، ﻲﺒﺼﻋ ﻢﻳﻼﻋ
ﻲﻧاور ) 19،20 ( و ﻲﻧاﻮﺨﺘﺳا ﻪﺘﻴﺴﻧاد ﺶﻫﺎﻛ و
ﻜﺷ ﺶﻳاﺰﻓا ﻲﮕﺘﺴ
ﻲﻧاﻮﺨﺘﺳا ﺪﺷﺎﺑ هاﺮﻤﻫ
) 21
، 22 (.
ﻲﺗﺎﻌﻟﺎﻄﻣ زا ﻪﻛ ﺖﻓﺮﺸﻴﭘ ﭙﻳﺎﻫ ﺮ ﺖﻤﺳ ﻪﺑ ﻲﻨﻴﻟﺎﺑ ﺖﺤﺗ يﺪﻴﺋوﺮﻴﺗ
ﭙﻳﺎﻫ ﺮ رﺎﻜﺷآ يﺪﻴﺋوﺮﻴﺗ ﺪﻨﻛ ﺖﻳﺎﻤﺣ ﻲﻨﻴﻟﺎﺑ
ﺞﻳﺎﺘﻧ ، ﺘﻣ ﻗﺎﻨ ﻀ ﻪﺘﺷاد ﻲ ﺪﻧا
ﺑ ﻪ هوﻼﻋ رد تﺎﻌﻟﺎﻄﻣ ﻲﻓﺎﻛﺎﻧ ﻪﻧﻮﻤﻧ ﻢﺠﺣ هﺪﺷ مﺎﺠﻧا هدﻮﺑ
و ﺖﻴﻌﻤﺟ
هﺪﺷ ﻪﻌﻟﺎﻄﻣ
، ﺪﻧا ﻪﺘﺷاد ﻲﺘﻴﻤﻫا ﻞﺑﺎﻗ ﺲﻧﺎﺠﺗ مﺪﻋ )
26 - 14،23 (.
رد ﺪﻴﺋوﺮﻴﺗ دﺮﻜﻠﻤﻋ لﻼﺘﺧا عﻮﻴﺷ هدرﻮﺨﻟﺎﺳ ﺖﻴﻌﻤﺟ
ًﺎﺻﻮﺼﺨﻣ رد
نﺎﻧز ﻦﺴﻣ ﺎﻴﻧﺎﺘﻳﺮﺑ ﺑ ﻻﺎ ﺖﺳا هﺪﺷ شراﺰﮔ .
وآﺮﺑ در عﻮﻴﺷ ﻲﺒﻳﺮﻘﺗ يﺪﻴﺋوﺮﻴﺗ تﻻﻼﺘﺧا
رد ﻲﻨﻴﻟﺎﺑ ﺖﺤﺗ ﺖﻴﻌﻤﺟ
ترﻮﺻ ﻪﺑ هدرﻮﺨﻟﺎﺳ
و هدﻮﺑ توﺎﻔﺘﻣ ﻪﺟﻮﺗ ﻞﺑﺎﻗ سﺎﺳا ﺮﺑ
هوﺮﮔ يﺎﻫ يداﮋﻧ
، ﺖﻓﺎﻳرد ناﺰﻴﻣ
ﺪﻳ رد ﻲﻳاﺬﻏ ﻢﻳژر و
ﻲﺘﻧآ عﻮﻴﺷ يدﺎﺑ
ﺮﻴﻐﺘﻣ يﺪﻴﺋوﺮﻴﺗﺪﺿ يﺎﻫ
ﻲﻣ ﺪﺷﺎﺑ ) 30 - 27 (.
رد ﻲﻨﻴﻟﺎﺑ ﺖﺤﺗ ﻢﺴﻳﺪﻴﺋوﺮﻴﺗﻮﭙﻳﺎﻫ عﻮﻴﺷ ﺖﻴﻌﻤﺟ
ﺎﭘورا هدرﻮﺨﻟﺎﺳ و
ﺎﻜﻳﺮﻣآ زا 4 / 1
% رد ﺎﺘﺳور ﺖﻴﻌﻤﺟ ﻳ
يﺪﺋﻮﺳ ﻲ )
31 ( ﺎﺗ
8 / 7
% رد ﺐﻠﻗ ﻪﻌﻟﺎﻄﻣ ﮕﻴﻨﻣاﺮﻓ
ﻬ مﺎ ) 25 ( ﻲﻨﻌﻳ 5 ﺮﺑاﺮﺑ ﻲﻣ توﺎﻔﺗ ﺪﻨﻛ
.
ﻲﻣ ﺮﻈﻧ ﻪﺑ ﺪﺳر
ﺎﺑ ﺖﺤﺗ ﻢﺴﻳﺪﻴﺋوﺮﻴﺗﻮﭙﻳﺎﻫ ﻲﻨﻴﻟ
رد رد نﺎﻧز ﺎﺑ ﻪﺴﻳﺎﻘﻣ
نادﺮﻣ ﺮﺗﻻﺎﺑ ﺪﺷﺎﺑ 18]
- 7 % ﺮﺑاﺮﺑ رد 15 - 2
% )[
33
، 30
، 27 (.
ﻪﻌﻟﺎﻄﻣ يا
ﻪﻛ رد رد ﺲﻴﻠﮕﻧا ﻦﻴﻐﻟﺎﺑ
رد ﻪﻤﻫ يﺎﻫ هدر ﻲﻨﺳ نﺎﺸﻧ ﺖﻓﺮﮔ مﺎﺠﻧا
ﻪﻛ داد يﺪﻴﺋوﺮﻴﺗﻮﭙﻳﺎﻫ ﻲﻨﻴﻟﺎﺑ ﺖﺤﺗ
نﺎﻧز رد ﺎﺑ ﻻﺎﺑ ﻦﺘﻓر ﻦﺳ ا ﺶﻳاﺰﻓ
ﻲﻣ ﺑﺎﻳ ﺪ ) ﻪﺑ نﺪﻴﺳر 18
% رد ﻦﺳ يﻻﺎﺑ 74 ﻲﮕﻟﺎﺳ ( د رد ﻪﻛ ﻲﻟﺎﺣ ر
ًﺎﺘﺒﺴﻧ ﺪﺣ رد نادﺮﻣ ﺘﺑﺎﺛ
ﻲ ) 5 - 2 (%
ﻲﻣ ﻲﻗﺎﺑ ﺪﻧﺎﻣ ) 33 (.
ﺮﻃﺎﺧ ﻪﺑ دﺮﻜﻠﻤﻋ لﻼﺘﺧا يﻻﺎﺑ عﻮﻴﺷ
رد يﺪﻴﺋوﺮﻴﺗ نارﺎﻤﻴﺑ
يﻻﺎﺑ 60 لﺎﺳ
، ﻦﻤﺠﻧا ﺖﺴﻳژﻮﻟﻮﻨﻳﺮﻛوﺪﻧا ﻲﻨﻴﻟﺎﺑ يﺎﻫ
ﺎﻜﻳﺮﻣآ
ﺧا يﺮﮕﻟﺎﺑﺮﻏ ﺘ
دﺮﻜﻠﻤﻋ لﻼ رد يﺪﻴﺋوﺮﻴﺗ
يﻻﺎﺑ نﺎﻧز 60
لﺎﺳ ار
هدﺮﻛ ﻪﻴﺻﻮﺗ ﺪﻧا
) 34 ( درﻮﻣ رد ﻲﻟو يﺪﻴﺋوﺮﻴﺗﻮﭙﻴﻫ نﺎﻣرد
و
يﺪﻴﺋوﺮﻴﺗﺮﭙﻴﻫ ﻲﻨﻴﻟﺎﺑ ﺖﺤﺗ
دراﺪﻧ دﻮﺟو ﺮﻈﻧ قﺎﻔﺗا .
رﻮﺸﻛ رد ناﺮﻳا
ﺮﺿﺎﺣ لﺎﺣ ﻖﻃﺎﻨﻣ وﺰﺟ
ﺎﺑ دﻮﺒﻤﻛ ﺪﻳ ﻲﻤﻧ بﻮﺴﺤﻣ دﻮﺷ
ﻲﻟو
لﻼﺘﺧا دﺮﻜﻠﻤﻋ يﺪﻴﺋوﺮﻴﺗ زا ﻲﻜﻳ
ﻲﻠﺻا فاﺪﻫا ﺖﻣﻼﺳ
رد ناﺮﻳا
ﺖﺳا ) 35 (.
لﺎﺳ رد ﺎﻫ ي ﺧا ﻴ ﺮ يﺪﻴﺋوﺮﻴﺗ لﻼﺘﺧا عﻮﻴﺷ رد
نﺎﻧز
ناﺮﻳا رد ﻦﺴﻣ رﺮﺑ
ﺖﺳا هﺪﺸﻧ ﻲﺳ .
ﻪﻌﻟﺎﻄﻣ ﻦﻳا فﺪﻫ عﻮﻴﺷ ﻲﺳرﺮﺑ
لﻼﺘﺧا يﻻﺎﺑ نﺎﻧزرد يﺪﻴﺋوﺮﻴﺗ 60
ﻲﻣ لﺎﺳ ﺪﺷﺎﺑ .
شور ﻲﺳرﺮﺑ
ﻪﻌﻟﺎﻄﻣ ﻦﻳا زا ﻲﻌﻄﻘﻣ
رﻮﻳﺮﻬﺷ هﺎﻣ 1385 ﺖﺸﻬﺒﻳدرا ﺖﻳﺎﻐﻟ
1386 رد ﻲﻗﺮﺷ نﺎﺠﻳﺎﺑرذآ نﺎﺘﺳا ﺰﻛﺮﻣ )
ﺰﻳﺮﺒﺗ ( ﺪﺷ مﺎﺠﻧا .
ﻪﻧﻮﻤﻧ ﺮﺑ ﻞﻤﺘﺸﻣ يا 1150
ﺮﻔﻧ ﺎﺑ يﺮﻴﮔ ﻪﻧﻮﻤﻧ ﻲﻓدﺎﺼﺗ
ﺎﺑ
هدﺎﻔﺘﺳا زا تﺎﻋﻼﻃا هﺪﺷ ﺖﺒﺛ ﻲﺘﺷاﺪﻬﺑ ﺰﻛاﺮﻣ رد
ﺪﺷ بﺎﺨﺘﻧا .
زا ﺲﭘ ﻪﻌﻟﺎﻄﻣ رد ﺖﻛﺮﺷ ﻪﺑ ﻞﻳﺎﻤﺗ ﻪﻛ يداﺮﻓا ﻦﺘﺷاﺬﮔ رﺎﻨﻛ
ﺪﻨﺘﺷاﺪﻧ
، رد ﺖﻳﺎﻬﻧ 1000 ﺮﻔﻧ ) 6 / 89
% ( ﻲﻓدﺎﺼﺗ ترﻮﺻ ﻪﺑ بﺎﺨﺘﻧا
و ﺪﻧﺪﺷ ﻪﻌﻟﺎﻄﻣ دراو .
ﻢﻧﺎﺧ مﺎﻤﺗ ﻪﻌﻟﺎﻄﻣ ﻪﺑ دورو رﺎﻴﻌﻣ يﺎﻫ
60
ﺳ ﻻﺎﺑ و لﺎ ﺮﺧ رﺎﻴﻌﻣ و دﻮﺑ ﺰﻳﺮﺒﺗ ﺮﻬﺷ ﻦﻛﺎﺳ ﺮﺗ ﻼﺘﺑا ﻪﻌﻟﺎﻄﻣ زا جو
يرﺎﻤﻴﺑ ﻪﺑ ﻪﻘﺑﺎﺳ و ﺎﻫ ﻲﻤﻴﺧﺪﺑ ،يﻮﻴﻠﻛ و يﺪﺒﻛ ﻪﺘﻓﺮﺸﻴﭘ يﺎﻫ
رد ﺪﻴﺋوﺮﻴﺗ دﺮﻜﻠﻤﻋ لﻼﺘﺧا
... 150
ﺖﺴﺗ رد ﺮﺛﻮﻣ يﺎﻫوراد فﺮﺼﻣ
،نورادﻮﻴﻣآ ﺮﻴﻈﻧ يﺪﻴﺋوﺮﻴﺗ يﺎﻫ
،ﺪﻴﺋﻮﻜﻴﺗرﻮﻛﻮﻠﮔ دﻮﺑ ﻦﻴﺋﻮﺗ ﻲﻨﻓ و مﻮﻴﺘﻴﻟ تﺎﻨﺑﺮﻛ
. ﻪﺑ ﻖﻴﻘﺤﺗ ﻦﻳا
ﺰﻳﺮﺒﺗ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﻖﻴﻘﺤﺗ ﻪﺘﻴﻤﻛ ﻪﻠﻴﺳو ﺪﻴﺋﺎﺗ
ﺪﺷ .
تﺎﻋﻼﻃا ﻚﻴﻓاﺮﮔﻮﻣد نارﺎﻤﻴﺑ ﻲﻜﺷﺰﭘ و
رد درﻮﻣ يرﺎﻤﻴﺑ ﻪﻘﺑﺎﺳ
ﺪﻴﺋوﺮﻴﺗ ﻲﻓﺮﺼﻣ يﺎﻫوراد و ي ﻪﻣﺎﻨﺸﺳﺮﭘ ﻂﺳﻮﺗ
ﺪﻧﺪﺷ ﺖﺒﺛ .
ﺪﻌﺑ زا
ﺬﺧا نﻮﺧ ﻪﻧﻮﻤﻧ ﻪﻣﺎﻧ ﺖﻳﺎﺿر ﺪﻳرو
ي داﺮﻓا رد ﺖﻴﻌﺿو ﺎﺘﺷﺎﻧ ﺬﺧا
ﺪﻳدﺮﮔ . ﺮﺳ ﺬﺧا نﻮﺧ ﻪﻧﻮﻤﻧ م هﺪﺷ
10 ﺪﻌﺑ ﻪﻘﻴﻗد زا
دﺎﺠﻳا ﻪﺘﺨﻟ و
ﺪﻌﺑ زا 10 ژﻮﻔﻳﺮﺘﻧﺎﺳ ﻪﻘﻴﻗد ﺎﺑ
رود 3000 رد د ﻪﻘﻴﻗد ر يﺎﻣد قﺎﺗا
اﺪﺟ ﺪﺷ و ه زا ﻞﺒﻗ ﻲﻣﺮﺳ يﺎﻫ ﻪﻧﻮﻤﻧ ﺰﻴﻟﺎﻧآ
رد يﺎﻣد 20 - ﻪﺟرد
داﺮﮔ ﻲﺘﻧﺎﺳ ﺪﻧﺪﺷ ﻲﻣ يراﺪﻬﮕﻧ
. دﺮﻜﻠﻤﻋ يﺎﻫ ﺖﺴﺗ يﺪﻴﺋوﺮﻴﺗ
ﺢﻄﺳ ﻞﻣﺎﺷ رد TSH
داﺮﻓا مﺎﻤﺗ درﻮﻣ
ﻪﻌﻟﺎﻄﻣ مﺎﺠﻧا و دازآ ﺢﻄﺳ
و T4
و T3
يدﺎﺑ ﻲﺘﻧآ ﺢﻄﺳ رد لﺎﻣوزوﺮﻜﻴﻣ ﻲﺘﻧآ
ﻪﻛ يداﺮﻓا
ﺢﻄﺳ ﻲﻌﻴﺒﻃﺮﻴﻏ ﺪﻨﺘﺷاد TSH
رﺮﺑ ﺪﺷ ﻲﺳ . ﺎﺑ نارﺎﻤﻴﺑ ﺺﻴﺨﺸﺗ
ﻢﺴﻳﺪﻴﺋوﺮﻴﺗﻮﭙﻳﺎﻫ ﺎﻳزﻮﻜﻴﺴﻛﻮﺗوﺮﻴﺗ
ًﺎﺒﻗﺎﻌﺘﻣ ﺖﺤﺗ ﺐﺳﺎﻨﻣ ﻞﻜﺷ ﻪﺑ
راﺮﻗ نﺎﻣرد ﺪﻨﺘﻓﺮﮔ
.
ﻲﻣﺮﺳ ﺢﻄﺳ و TSH
و FT4
وFT3
ﻲﺘﻧآ ﻲﺘﻧآ لﺎﻣوزوﺮﻜﻴﻣ ﻪﺑ يدﺎﺑ
شور ﻛ ﻲﻤ ﺖﻨﺴﻨﻴﻣﻮﻟ
(Chemiluminescent)
راﺮﻗ ﻲﺑﺎﻳزرا ﺖﺤﺗ
ﺪﻨﺘﻓﺮﮔ . ﺪﺻرد ﺐﻳﺮﺿ ﺐﻴﺗﺮﺗ ﻪﺑ تاﺮﻴﻴﻐﺗ
9 / 7 ، 2 / 6 و 3 / 8 ﺪﺻرد ياﺮﺑ وTSH
و FT4
دﻮﺑ FT3
.
ﺢﻄﺳ لﺎﻣﺮﻧ ياﺮﺑ ﻲﻫﺎﮕﺸﻳﺎﻣزآ
،TSH
5mu/L
/ 4 ﺎﺗ 3 / 0 ياﺮﺑ ،
،FT4 ng/dl
9 / 1 ﺎﺗ 8 / 0
، ياﺮﺑ
،FT3 pg/ml
2 / 4 ﺎﺗ 2 / 2 ياﺮﺑ و
زا ﺮﺘﻤﻛ يدﺎﺑ ﻲﺘﻧآ لﺎﻣوزوﺮﻜﻴﻣ ﻲﺘﻧآ
mIu/l
75 دﻮﺑ .
هداد يرﺎﻣآ ﻞﻴﻠﺤﺗ راﺰﻓا مﺮﻧ زا هدﺎﻔﺘﺳا ﺎﺑ ﺎﻫ
14 و SPSS
يﺎﻫ نﻮﻣزآ ﺖﺴﺗ ،ﺮﺋﻮﻜﺳا يﺎﻛ يرﺎﻣآ
Exact Fisher
و ﺐﻳﺮﺿ
نﻮﺳﺮﻴﭘ ﺪﺷ مﺎﺠﻧا . ﺮﺘﻤﻛ P
زا 05 / 0 زا ﺮﻈﻧ يرﺎﻣآ راد ﻲﻨﻌﻣ رد
ﺪﺷ ﻪﺘﻓﺮﮔﺮﻈﻧ و
ﺎﺑ ﻖﻴﺒﻄﺗ شور ﻪﺑ لﺎﻣﺮﻧ ﻊﻳزﻮﺗ
Kolmogorov-
Smirnav
ﺖﻓﺮﮔراﺮﻗ ﻲﺳرﺮﺑ ﺖﺤﺗ .
ﺞـﻳﺎـﺘﻧ ﻢﻧﺎﺧ ﻪﻌﻟﺎﻄﻣ رد هﺪﻨﻨﻛ ﺖﻛﺮﺷ داﺮﻓا يﺎﻫ
89 - 60 ﺪﻧدﻮﺑ ﻪﻟﺎﺳ
ﻲﻨﺳ ﻦﻴﮕﻧﺎﻴﻣ ﻪﻛ ﺎﻬﻧآ
) 4 /
±5 5 / 64 ( دﻮﺑ لﺎﺳ .
ﻲﻣﺮﺳ ﻲﻠﻛ ﺢﻄﺳ
،TSH
44mu/l
/
±4 31 / 2 دﻮﺑ . 873 ﺮﻔﻧ
زا ﺮﻈﻧ دﺮﻜﻠﻤﻋ رد يﺪﻴﺋوﺮﻴﺗ دوﺪﺤﻣ
راﺮﻗ ﻲﻌﻴﺒﻃ ﺪﻨﺘﺷاد
. رد
127 ﺮﻔﻧ ﻲﻣﺮﺳ ﺢﻄﺳ ﺪﺷ شراﺰﮔ ﻲﻌﻴﺒﻃ ﺮﻴﻏ TSH
. 73 ﺮﻔﻧ زا
ﺢﻄﺳ نارﺎﻤﻴﺑ ﻦﻳا ﻻﺎﺑ TSH
و 54 ﺮﻔﻧ ﺢﻄﺳ ﻦﻴﺋﺎﭘ TSH
ﺪﻨﺘﺷاد و ﺢﻄﺳ ﻦﻴﺑ ﻲﻃﺎﺒﺗرا و TSH
نارﺎﻤﻴﺑ ﻦﺳ هﺪﻫﺎﺸﻣ
ﺪﺸﻧ ) لوﺪﺟ 1 .(
لوﺪﺟ ) 2 ( : عﻮﻴﺷ يژﻮﻟﻮﻴﻣﺪﻴﭘا تﺎﻌﻟﺎﻄﻣ رد ﻻﺎﺑTSH
) 24 (
ﻖﻘﺤﻣ مﺎﻧ ﻪﻌﻟﺎﻄﻣ درﻮﻣ داﺮﻓا ﻦﺳ ﺲﻨﺟ
داﺪﻌﺗ يﺪﻴﺋوﺮﻴﺗﻮﭙﻳﺎﻫ ﺪﺻرد
لﺎﻣﺮﻧ ناﺰﻴﻣ TSH
Nystrom 38
1981
60 + 100
% ﺚﻧﻮﻣ 222
6 / 8 8>
Falkenberg 31
1983
60 + 100
% ﺚﻧﻮﻣ 1442
27 / 2 7>
Sawin 25
60 1985
41 + % ﺮﻛﺬﻣ
59 % 2139 ﺚﻧﻮﻣ
6 / 13 5>
Parie 24
60 1991
41 + % ﺮﻛﺬﻣ
59 % ﺚﻧﻮﻣ 1210
6 / 11 5>
Chuang 35
1998
65 + 57
% ﺮﻛﺬﻣ
43 % ﺚﻧﻮﻣ 917
3 65>
/ 4
Wilson 39
65 2006
49 + % ﺮﻛﺬﻣ
51 % ﺚﻧﻮﻣ 5960
4 5>
/ 5
ﺮﻴﺧا ﻪﻌﻟﺎﻄﻣ 60
+ 100
% ﺚﻧﻮﻣ 1000 3
/ 7 5>
/ 4
) 87 / 6 و X2=
55 / 0 و p=
8 (df=
نارﺎﻜﻤﻫ و ﺮﻓﺎﻴﻧ اﺮﺘﻴﻣ
151
73 ﺮﻔﻧ زا داﺮﻓا ﺎﺑ ﻲﻨﺳ ﻦﻴﮕﻧﺎﻴﻣ 9
/
±6 8 / 65 ﺢﻄﺳ
TSH
ﺪﻨﺘﺷاد ﻻﺎﺑ ﻲﻣﺮﺳ ﻲﻣﺮﺳ ﺢﻄﺳ
رد TSH
زا هوﺮﮔ ﻦﻳا 6mu/l
/ 4
ﺎﺗ 104 ) ﻂﺳﻮﺘﻣ
TSH
81:
/
±13 16 / 10 ( ﺮﻴﻐﺘﻣ دﻮﺑ . ﺮﻳدﺎﻘﻣ
ﻲﻣﺮﺳ
ًﺎﻳﻮﻗ TSH
ﺎﺑ ﺢﻄﺳ رد FT4
ﺖﺷاد ﻲﻧاﻮﺨﻤﻫ هوﺮﮔ ﻦﻳا
) 0005 /
<0 و P
73 و n=
50 / 0 - (.r=
ﻦﻳا زا 73 ﺮﻔﻧ 15 ﺮﻔﻧ
ﻲﻣﺮﺳ ﺢﻄﺳ و ﻦﻴﺋﺎﭘ FT4
58 ﺮﻔﻧ ﺢﻄﺳ رد FT4
دوﺪﺤﻣ ه لﺎﻣﺮﻧ
ﺘﺷاد ﺪﻨ . رﺎﻜﺷآ ﻲﻨﻴﻟﺎﺑ يﺪﻴﺋوﺮﻴﺗﻮﭙﻳﺎﻫ عﻮﻴﺷ 5
/ 1
% ) ﻂﺳﻮﺘﻣ
ﻲﻣﺮﺳ ﺢﻄﺳ 55:TSH
/
±2 1 / 25 ( و ﺖﺤﺗ يﺪﻴﺋوﺮﻴﺗﻮﭙﻳﺎﻫ عﻮﻴﺷ
ﻲﻨﻴﻟﺎﺑ 8 / 5
% دﻮﺑ .
54 ﺮﻔﻧ ) ﻦﺳ ﻂﺳﻮﺘﻣ 1
/
±5 5 / 64 لﺎﺳ ( ﻲﻣﺮﺳ ﺢﻄﺳ
TSH
ﺪﻨﺘﺷاد ﻦﻴﺋﺎﭘ )
29 MU/L
/ 0 ﺎﺗ 02 / 0 ( و ﻂﺳﻮﺘﻣ ﻲﻣﺮﺳ TSH
045 /
±0 067 / 0 دﻮﺑ mU/L
. ﻦﻳا زا 54 ﺮﻔﻧ 12 ﺮﻔﻧ ﺎﺑ ﺢﻄﺳ
TSH
ﻦﻴﺋﺎﭘ ) ﻂﺳﻮﺘﻣ ﻲﻣﺮﺳ TSH
04 /
±0 06 / 0 ( ﺢﻄﺳ ﻦﻴﺋﺎﭘ FT4
ﺪﻨﺘﺷاد . 1 ﺮﻔﻧ ﺢﻄﺳ ﺎﺑ ﻲﻣﺮﺳ يﻻﺎﺑ FT3
و ﻦﻴﺋﺎﭘ TSH FT4
و ﺖﺷاد ﻲﻌﻴﺒﻃ 41
ﺮﻔﻧ ﺎﺑ ﺢﻄﺳ ﻲﻌﻴﺒﻃ TSH
و FT3 FT4
ﺪﻨﺘﺷاد ﻲﻌﻴﺒﻃ .
ﻴﺗﻮﭙﻳﺎﻫ عﻮﻴﺷ رﺎﻜﺷآ ﻢﺴﻳﺪﻴﺋوﺮ
و ﻲﻨﻴﻟﺎﺑ
و ﻲﻨﻴﻟﺎﺑ ﺖﺤﺗ يﺪﻴﺋوﺮﻴﺗﻮﭙﻳﺎﻫ ﺐﻴﺗﺮﺗ ﻪﺑ ﺲﻳزﻮﻜﻴﺴﻛﻮﺗ T3
2 / 1
% ، 1 / 4 ، 1 / 0
% دﻮﺑ .
ﺮﺘﻴﺗ ﻲﺘﻧآ رد لﺎﻣوزوﺮﻜﻴﻣ ﻲﺘﻧآ يدﺎﺑ داﺮﻓا
ﺎﺑ ﻻﺎﺑ TSH
8 / 60 %
ﻪﻛ دﻮﺑ 8 / 88 % زا داﺮﻓا ﻦﻳا ﺢﻄﺳ
يﻻﺎﺑ TSH
10 و 51
% زا ﺎﻬﻧآ
ﺢﻄﺳ يﻻﺎﺑ TSH
5 / 4 و ﺮﺘﻤﻛ ﺎﻳ يوﺎﺴﻣ 10 ﺪﻨﺘﺷاد . ﺑ ﻲﺳرﺮ
ﺎﺑ ﻪﺠﻴﺘﻧ ﻦﻳا ﺮﺸﻴﻓ ﺖﺴﺗ
رادﺎﻨﻌﻣ دﻮﺑ ) 004 / 0 و P=
1 و df=
29 / 8 (.x2=
لوﺪﺟ ) 1 ( : ناﺰﻴﻣ (mU/liter) ﻲﻨﺳ يﺎﻬﻫوﺮﮔ سﺎﺳا ﺮﺑ ﻪﻌﻟﺎﻄﻣ درﻮﻣ هوﺮﮔ رد TSH
ﻦﺳ داﺪﻌﺗ
TSH <0/3 >4/5 0/3-4/5
32 41 554
64 - 60
1 / 5
% %6/5 %88/4
12 13 154
69 - 65
%6/7 %7/3 %86
6 9 110
74 - 70
8 / 4
% %7/2 %88
3
7 37
%6/4 %14/9 %78/7
1
3 18
80
> %5/5 %7,3 %87/3
) 87 / 6 و X2=
55 / 0 و p=
8 (df=
ﺚﺤـﺑ ﻻﺎﺑ عﻮﻴﺷﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ و
يﺪﻴﺋوﺮﻴﺗ تﻻﻼﺘﺧا ﻪﺟﻮﺗ ﻞﺑﺎﻗ
نﺎﻧزرد ار هدرﻮﺨﻟﺎﺳ ﺎﺗ
ﻳ ﺪﻳﺎﻤﻧ ﻲﻣ ﺪﻴ .
ﻪﺑﺎﺸﻣ تﺎﻌﻟﺎﻄﻣ ﺞﻳﺎﺘﻧ لوﺪﺟ رد
2 هﺪﻣآ ﺖﺳا . ﺎﻗ ﻪﺘﻜﻧ ﻪﺟﻮﺗ ﻞﺑ
نآ ﻪﻛ ﺖﺳا رد ﺮﺘﺸﻴﺑ عﻮﻴﺷ تﺎﻌﻟﺎﻄﻣ ﻦﻳا ﻫ
ﺎ يﺪﻴﺋوﺮﻴﺗﻮﭙﻳ ﻪﺑﺎﺸﻣ
ﺖﺳا هدﻮﺑ ﺎﻣ ﻪﻌﻟﺎﻄﻣ .
ﻂﻘﻓ ودرد ﻪﻌﻟﺎﻄﻣ
Falkenberg
و ﺶﻧارﺎﻜﻤﻫ
) رد لﺎﺳ 1983 ( ) 31 ( و
Chuang
و نارﺎﻜﻤﻫ ) رد لﺎﺳ
1998 ( ) 35 ( عﻮﻴﺷ يﺪﻴﺋوﺮﻴﺗﻮﭙﻳﺎﻫ ﻦﻴﺋﺎﭘ تﺎﻌﻟﺎﻄﻣ ﺮﻳﺎﺳ ﻪﺑ ﺖﺒﺴﻧ
ﺖﺳا هدﻮﺑ )
ﺐﻴﺗﺮﺗ ﻪﺑ 2
و 3 ﺪﺻرد (
، ﻪﻛ ﺷ زا ﻲﺷﺎﻧ توﺎﻔﺗ ﻦﻳا ﺪﻳﺎ
ﻳﺮﻌﺗ رد تﻼﻜﺸﻣ ﻒ
ﺺﺧﺎﺷ ﻲﺳرﺮﺑ درﻮﻣ يﺎﻫ ﻪﻧﻮﻤﻧ بﺎﺨﺘﻧا يﺎﻫ
شور و ﺪﺷﺎﺑ ﺪﻴﺋوﺮﻴﺗ دﺮﻜﻠﻤﻋ يﺮﻴﮔ هزاﺪﻧا ﻒﻠﺘﺨﻣ يﺎﻫ .
رد ﺪﻴﺋوﺮﻴﺗ دﺮﻜﻠﻤﻋ لﻼﺘﺧا
... 152
ﻫ عﻮﻴﺷ تﺎﻌﻟﺎﻄﻣ زا ﻲﻤﻛ داﺪﻌﺗ رد ﺎ
درﻮﻣ يﺪﻴﺋوﺮﻴﺗﺮﭙﻳ
ﻪﻌﻟﺎﻄﻣ ود رد ﻲﻟو ﺖﺳا ﻪﺘﻓﺮﮔ راﺮﻗ ﻲﺳرﺮﺑ
Parle
و
نارﺎﻜﻤﻫ ) 24 ( و
Chuang
نارﺎﻜﻤﻫ و )
35 ( ﻪﻛ شور زا ﺎﺑ يﺎﻫ
ﻻﺎﺑ ﺖﻴﺳﺎﺴﺣ هزاﺪﻧا ياﺮﺑ
يﺮﻴﮔ ﻦﻳا عﻮﻴﺷ هﺪﺷ هدﺎﻔﺘﺳا TSH
ﺖﺳا هدﻮﺑ ﺎﻣ ﻪﻌﻟﺎﻄﻣ ﺎﺑ ﻪﺑﺎﺸﻣ لﻼﺘﺧا )
ﺐﻴﺗﺮﺗ ﻪﺑ 3
/ 6 و 3 / 4
ﺪﺻرد .(
ﺢﻄﺳ ﻪﻛ يداﺮﻓا رد ﺮﻴﺧا ﻪﻌﻟﺎﻄﻣ رد ﺢﻄﺳ ﺪﻨﺘﺷاد ﻻﺎﺑ TSH
T4
ﺑ دازآ ﻪ دﻮﺑ ﻦﻴﺋﺎﭘ نآ ﺎﺑ سﻮﻜﻌﻣ رﻮﻃ ﻪﻛ
تﺎﻌﻟﺎﻄﻣ ﺪﻴﺋﺎﺗرد ﻗ
ﻲﻠﺒ
ﺪﺷﺎﺑ ﻲﻣ ) 36
، 35
، 24 (.
ﺢﻄﺳ ﻪﻛ ﺖﺳا نآ ﺮﮕﻧﺎﻴﺑ ﺮﻣا ﻦﻳا
TSH
ًﺎﻤﻴﻘﺘﺴﻣ يﺪﻴﺋوﺮﻴﺗ يﺎﻬﻧﻮﻣرﻮﻫ ﺪﻴﻟﻮﺗ ﺖﻴﻌﺿو هﺪﻨﻨﻛ ﺲﻜﻌﻨﻣ
ﺪﺷﺎﺑ ﻲﻣ . ﺖﺳا نآ ﺮﮕﻧﺎﺸﻧ ﻲﻠﺒﻗ تﺎﻌﻟﺎﻄﻣ ﻪﻛ
ﻪﻛ يداﺮﻓا زا ﺮﺗﻻﺎﺑ TSH
10 ﻪﺘﺷاد ﺪﻧا ﻫ فﺮﻃ ﻪﺑ ﺎ
ﺖﻓﺮﺸﻴﭘ ﺢﺿاو يﺪﻴﺋوﺮﻴﺗﻮﭙﻳ
ﻲﻣ ﺪﻨﻨﻛ ) 37
، 36
، 24 ( ﻲﻣﺮﺳ ﺢﻄﺳ ﺎﺑ داﺮﻓا يﺮﻴﮕﻴﭘ ﻦﻳاﺮﺑﺎﻨﺑ
ﻫ فﺮﻃ ﻪﺑ ﺖﻓﺮﺸﻴﭘ ﺮﻈﻧ زا ،ﻻﺎﺑ TSH
ﺎ ﺎﺑ ﺢﺿاو يﺪﻴﺋوﺮﻴﺗﻮﭙﻳ
ﺖﺳا ﺖﻴﻤﻫا .
ﺲﻜﻋﺮﺑ
، ﻲﻣ ﺮﻈﻧ ﻪﺑ ﻚﺴﻳر ﺪﺳر
فﺮﻃ ﻪﺑ ﺖﻓﺮﺸﻴﭘ
ﻲﻧارﺎﻤﻴﺑ رد ﺢﺿاو زﻮﻜﻴﺴﻛﻮﺗوﺮﻴﺗ ﻪﻛ
ﻦﻴﺋﺎﭘ TSH
زا ﺮﺗ لﺎﻣﺮﻧ
ﺰﺟ ﺪﻧراد ﻳ ﺪﺷﺎﺑ ﻲ ) 24 (.
ﺢﻄﺳ رد يﺮﻴﻴﻐﺗ ﺮﻴﺧا ﻪﻌﻟﺎﻄﻣ رد ﺪﺸﻧ هﺪﻫﺎﺸﻣ ﻦﺳ ﺎﺑ TSH
دﻮﺑ ﻲﻠﺒﻗ تﺎﻌﻟﺎﻄﻣ ﺎﺑ ﻪﺑﺎﺸﻣ ﻪﻛ ﺖﺳا ه
) 8 (.
دﻮﺟو ﺪﻴﺋوﺮﻴﺗ يﺎﻬﻳدﺎﺑ ﻲﺘﻧآ يﻻﺎﺑ ﺢﻄﺳ )
3 / 73 ﺪﺻرد ( رد نارﺎﻤﻴﺑ
ﻫ ﺎﺑ ﺎ ﺢﺿاو يﺪﻴﺋوﺮﻴﺗﻮﭙﻳ ﻪﻛ ﺖﺳا نآ ﺮﮕﻧﺎﻴﺑ ،ﺮﻴﺧا ﻪﻌﻟﺎﻄﻣ رد
ﻦﺴﻣ نﺎﻧز رد ﺪﻴﺋوﺮﻴﺗ يرﺎﻛ ﻢﻛ ﻲﻠﺻا ﺖﻠﻋ نﻮﻴﻤﻳاﻮﺗا تﻻﻼﺘﺧا ﺪﺷﺎﺑ ﻲﻣ ﻲﻠﺒﻗ تﺎﻌﻟﺎﻄﻣ ﺪﻴﺋﺎﺗ رد ﻪﻛ ﺖﺳا ﻲﻧاﺮﻳا )
35
، 30
، 8 (.
ﺠﻴﺘﻧ يﺮﻴﮔ ﻪ
ا ﻞﺻﺎﺣ ﺞﻳﺎﺘﻧ ز
دﺮﻜﻠﻤﻋ لﻼﺘﺧا ﻪﻛ داد نﺎﺸﻧ ﻪﻌﻟﺎﻄﻣ ﻦﻳا
ﺪﻴﺋوﺮﻴﺗ هداد ﺺﻴﺨﺸﺗ ﺐﻠﻏا و ﺖﺳا ﻊﻳﺎﺷ ﻦﺴﻣ نﺎﻧز رد
ناﻮﺗ ﻲﻣ و دﻮﺷ ﻲﻤﻧ دوز ﺺﻴﺨﺸﺗ ﺎﺑ
مﺎﮕﻨﻫ ) يﺮﻴﮔ هزاﺪﻧا
TSH
مﺮﺳ ( نآ ضراﻮﻋ زا دﺮﻛ يﺮﻴﮔﻮﻠﺟ
.
ﻦﻴﻨﭽﻤﻫ هﺪﻣآ ﺖﺳﺪﺑ يﻻﺎﺑ ﺮﺘﻴﺗ
لﺎﻣوزوﺮﻜﻴﻣ ﻲﺘﻧآ
يدﺎﺑ ﻲﺘﻧآ رد
6 / 60
% ﺎﺑ داﺮﻓا ﻪﺘﻜﻧ ﻦﻳا ﺪﻳﻮﻣ ﺪﻧاﻮﺗ ﻲﻣ ﻻﺎﺑTSH
ﻪﻛ ﺪﺷﺎﺑ هدرﻮﺨﻟﺎﺳ داﺮﻓا رد يﺪﻴﺋوﺮﻴﺗﻮﭙﻳﺎﻫ ﻲﻠﺻا ﺖﻠﻋ زﻮﻨﻫ
ﺖﺳا ﺪﻴﺋوﺮﻴﺗ ﻲﻨﻤﻳا دﻮﺧ يﺎﻫ يرﺎﻤﻴﺑ .
يراﺰﮕﺳﺎﭙﺳ
ﺖﻤﺸﺣ ﻦﻴﻣار ﺮﺘﻛد تﺎﻤﺣز زا نﺎﮔﺪﻨﺴﻳﻮﻧ )
ﺖﺴﻳژﻮﻟﻮﻴﻣﺪﻴﭘا (
،
هدازﺎﺟﻮﻗ ﻲﻀﺗﺮﻣ ﺮﺘﻛد )
رﺎﻣآ ﺺﺼﺨﺘﻣ (
، ﻲﻣﺎﻣا ﻪﻠﻌﺷ ﺮﺘﻛد )
لﻮﺌﺴﻣ
ﻲﻧﻮﻣرﻮﻫ هﺎﮕﺸﻳﺎﻣزآ (
و ﻫ يﺎﻫ ﻲﻳﺎﻤﻨﻫار و تاﺮﻈﻧ زا ﻦﻴﻨﭽﻤ
ﻲﺘﻣﺎﻘﺘﺳا ﺎﺿﺮﻴﻠﻋ ﺮﺘﻛد هﺪﻧزرا )
ﻲﻠﺧاد يﺎﻬﻳرﺎﻤﻴﺑ هوﺮﮔ رﺎﻴﺸﻧاد
ناﺮﻬﺗ هﺎﮕﺸﻧاد (
هﺪﻬﻋ ﺮﺑ لﺎﺳرا زا ﻞﺒﻗ ار ﻪﻟﺎﻘﻣ ﻦﻳا ﻲﻨﻴﺑزﺎﺑ ﻪﻛ
راد ار ﺮﻜﺸﺗ لﺎﻤﻛ ﺪﻨﺘﻓﺮﮔ ﻧ
ﺪ . زا ﻪﻟﺎﻘﻣ ﻦﻳا نﺎﮔﺪﻨﻨﻛ ﻪﻴﻬﺗ
نﺎﺘﺳا ﻲﺘﺷاﺪﻬﺑ ﺖﻧوﺎﻌﻣ ﻲﻗﺮﺷ نﺎﺠﻳﺎﺑرذآ
ﻦﻳا مﺎﺠﻧا رد ﻪﻛ
ﺗ ﺪﻧا ﻪﺘﺷاد يرﺎﻜﻤﻫ ﻖﻴﻘﺤ ﺪﻨﻳﺎﻤﻧ ﻲﻣ ﻲﻧادرﺪﻗ ﻪﻧﺎﻤﻴﻤﺻ
.
ﺰﻳﺮﺒﺗ هﺎﮕﺸﻧاد ﻲﺸﻫوﮋﭘ ﺖﻧوﺎﻌﻣ ﻲﻟﺎﻣ ﺖﻳﺎﻤﺣ ﺎﺑ ﻪﻌﻟﺎﻄﻣ ﻦﻳا ﺖﺳا ﻪﺘﻓﺮﮔ مﺎﺠﻧا .
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رد ﺪﻴﺋوﺮﻴﺗ دﺮﻜﻠﻤﻋ لﻼﺘﺧا
... 154
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رد ﺪﻴﺋوﺮﻴﺗ دﺮﻜﻠﻤﻋ لﻼﺘﺧا
... 156
Thyroid Dysfunction in the Elderly Women of Tabriz
Niafar M(MD)1*, Bahrami A(MD)2, Aliasgarzadeh A(MD)3, Gholami N(MD)4
1-4Department of Endocrinology and Metabolism, Tabriz University of Medical Sciences, Tabriz, Iran
Received: 3 May 2010 Accepted: 23 Dec 2010
Abstract
Introduction: The present study aimed to investigate the prevalence of thyroid dysfunction in the elderly women of Tabriz city; the largest city in North West Iran.
Methods: By using the records of the local household registry, a sample of 1000 subjects aged between 60 and 89 years(mean 64.54±5.41) was drawn by simple random sampling. Thyroid function tests including TSH concentration were done in all subjects and free T4 concentration, free T3 concentration and anti- microsomal antibodies were measured in those with abnormal TSH levels.
Results: Seventy-three(7.3%) participants had high(>4.5mU/liter), and 54(5.4%) had low (<0.3 mU/liter) TSH levels. The overall prevalence of thyroid dysfunction in the population under study was 12.7%. The prevalence of overt and subclinical hypothyroidism in study subjects were 1.5% and 4.1%, respectively.
Overt and subclinical hyperthyroidism was seen in 4.1% and 1.2%, respectively. High titers of anti- microsomal antibodies were found in 60.6% of those with high TSH levels.
Conclusion: The prevalence of abnormal biochemical thyroid function reported in the study is substantial and confirms previous reports in other populations. The prevalence of thyroid dysfunction is high in the elderly female population of Tabriz. The results provide useful baseline information for designing public health plans and tracking changes.
Keywords: Hypothyroidism; Women’s Health; Women; Thyroid FunctionTest; Thyrotropin
This paper should be cited as:
Niafar M, Bahrami A, Aliasgarzadeh A, Gholami N.Thyroid dysfunction in the elderly women of Tabriz.J Shahid Sadoughi Univ
Med Sci; 19(2): 148- 56.
*Corresponding author: Tel:+98 411 3810105, Email:[email protected]
