[1]孙宇,王艳,徐书杭,等.精准分层、合理干预:从《中国老年人甲状腺疾病诊疗专家共识(2021)》探讨老年亚临床甲减的合理诊治[J].国际内分泌代谢杂志,2023,43(06):521-524.[doi:10.3760/cma.j.cn121383-20220104-01002]
 Sun Yu,Wang Yan,Xu Shuhang,et al.Consensus and controversies of the diagnosis and treatment of subclinical hypothyroidism in the elderly[J].International Journal of Endocrinology and Metabolism,2023,43(06):521-524.[doi:10.3760/cma.j.cn121383-20220104-01002]
点击复制

精准分层、合理干预:从《中国老年人甲状腺疾病诊疗专家共识(2021)》探讨老年亚临床甲减的合理诊治()
分享到:

《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
43
期数:
2023年06期
页码:
521-524
栏目:
综述
出版日期:
2023-11-20

文章信息/Info

Title:
Consensus and controversies of the diagnosis and treatment of subclinical hypothyroidism in the elderly
作者:
孙宇1王艳2徐书杭3刘超3
1徐州医科大学附属宿迁医院内分泌科,宿迁 223800; 2徐州医科大学附属宿迁医院老年医学科,宿迁 223800; 3南京中医药大学附属中西医结合医院(江苏省中西医结合医院)内分泌科, 南京 210028
Author(s):
Sun Yu1 Wang Yan2 Xu Shuhang3 Liu Chao3.
1Department of Endocrinology and Metabolism, the Affiliated Suqian Hospital of Xuzhou Medical University,Suqian 223800,China; 2Department of Geriatrics, the Affiliated Suqian Hospital of Xuzhou Medical University, Suqian 223800, Chin
关键词:
老年人 亚临床功能减退症 心血管疾病 甲状腺激素替代治疗
Keywords:
Elderly Subclinical hypothyroidism Cardiovascular disease Thyroid hormone replacement therapy
DOI:
10.3760/cma.j.cn121383-20220104-01002
摘要:
亚临床甲状腺功能减退症(SCH)是老年人常见疾病之一。促甲状腺激素(TSH)的正常切点受年龄、碘营养状况等多种因素影响,显著影响了老年SCH的诊断和治疗。心血管疾病是老年SCH的主要终点事件,应根据TSH水平、年龄和心血管疾病及其危险因素指导老年SCH的干预。对于老年SCH患者是否需要进行左甲状腺素替代治疗,尤其是TSH在10~20 mU/L的这部分群体,替代治疗能否获益,尚需前瞻性的干预研究进行证实。
Abstract:
Subclinical hypothyroidism(SCH)is one of the common diseases in the elderly. The normal cut-off point for thyroid stimulating hormone(TSH)is influenced by a variety of factors, including age and iodine nutritional status, which significantly affects the diagnosis and treatment of SCH in the elderly. Cardiovascular disease is the major endpoint event of SCH in the elderly, and interventions for SCH in the elderly should be guided by TSH levels, age, and cardiovascular disease and its risk factors. Prospective intervention studies are needed to confirm the need for levothyroxin replacement therapy in elderly SCH patients, especially in this group with TSH in the range of 10-20 mU/L, and whether replacement therapy can be beneficial.

参考文献/References:

[1] Biondi B,Cappola AR,Cooper DS.Subclinical hypothyroidism: a review[J].JAMA,2019,322(2):153-160.DOI:10.1001/jama.2019.9052.
[2] 中华医学会老年医学分会老年内分泌代谢疾病学组,中华医学会内分泌学分会甲状腺学组.中国老年人甲状腺疾病诊疗专家共识(2021)[J].中华老年医学杂志,2021,40(5):529-549.DOI:10.3760/cma.j.issn.0254-9026.2021.05.001.
[3] 段宇,刘超,冯尚勇,等.江苏地区甲状腺功能减退症流行现状调查[J].中华内分泌代谢杂志,2008,24(3):275-277.DOI:10.3321/j.issn:1000-6699.2008.03.011.
[4] Hennessey JV,Espaillat R.Subclinical hypothyroidism:a historical view and shifting prevalence[J].Int J Clin Pract,2015,69(7):771-782.DOI:10.1111/ijcp.12619.
[5] Zhai X,Zhang L,Chen L,et al.An age-specific serum thyrotropin reference range for the diagnosis of thyroid diseases in older adults:a cross-sectional survey in china[J].Thyroid,2018,28(12):1571-1579.DOI:10.1089/thy.2017.0715.
[6] Vadiveloo T,Donnan PT,Murphy MJ,et al.Age- and gender-specific TSH reference intervals in people with no obvious thyroid disease in Tayside,Scotland:the thyroid epidemiology,audit,and research study(TEARS)[J].J Clin Endocrinol Metab,2013,98(3):1147-1153.DOI:10.1210/jc.2012-3191.
[7] Van de ven AC,Netea-Maier RT,Smit JW,et al.Thyrotropin versus age relation as an indicator of historical iodine intake[J].Thyroid,2015,25(6):629-634.DOI:10.1089/thy.2014.0574.
[8] Goichot B,Raverot V,Klein M,et al.Management of thyroid dysfunctions in the elderly.French Endocrine Society consensus statement 2019.Long version[J].Ann Endocrinol(Paris),2020,81(2-3):89-100.DOI:10.1016/j.ando.2020.04.010.
[9] Yang C,Lu M,Chen W,et al.Thyrotropin aggravates atherosclerosis by promoting macrophage inflammation in plaques[J].J Exp Med,2019,216(5):1182-1198.DOI:10.1084/jem.20181473.
[10] Inoue K,Ritz B,Brent GA,et al.Association of subclinical hypothyroidism and cardiovascular disease with mortality[J].JAMA Netw Open,2020,3(2):e1920745.DOI:10.1001/jamanetworkopen.2019.20745.
[11] Hak AE,Pols HA,Visser TJ,et al.Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women:the Rotterdam Study[J].Ann Intern Med,2000,132(4):270-278.DOI:10.7326/0003-4819-132-4-200002150-00004.
[12] Silva N,Santos O,Morais F,et al.Subclinical hypothyroidism represents an additional risk factor for coronary artery calcification,especially in subjects with intermediate and high cardiovascular risk scores[J].Eur J Endocrinol,2014,171(3):327-334.DOI:10.1530/EJE-14-0031.
[13] Tohidi M,Derakhshan A,Akbarpour S,et al.Thyroid dysfunction states and incident cardiovascular events:the tehran thyroid study[J].Horm Metab Res,2018,50(1):37-43.DOI:10.1055/s-0043-121031.
[14] Rodondi N,den Elzen WP,Bauer DC,et al; Thyroid Studies Collaboration.Subclinical hypothyroidism and the risk of coronary heart disease and mortality[J].JAMA,2010,304(12):1365-1374.DOI:10.1001/jama.2010.1361.
[15] Pasqualetti G,Pagano G,Rengo G,et al.Subclinical hypothyroidism and cognitive impairment:systematic review and meta-analysis[J].J Clin Endocrinol Metab,2015,100(11):4240-4248.DOI:10.1210/jc.2015-2046.
[16] Rieben C,Segna D,da Costa BR,et al.Subclinical thyroid dysfunction and the risk of cognitive decline:a meta-analysis of prospective cohort studies[J].J Clin Endocrinol Metab,2016,101(12):4945-4954.DOI:10.1210/jc.2016-2129.
[17] Blum MR,Bauer DC,Collet TH,et al.Subclinical thyroid dysfunction and fracture risk:a meta-analysis[J].JAMA,2015,313(20):2055-2065.DOI:10.1001/jama.2015.5161.
[18] Segna D,Bauer DC,Feller M,et al.Association between subclinical thyroid dysfunction and change in bone mineral density in prospective cohorts[J].J Intern Med,2018,283(9):56-72.DOI:10.1111/joim.12688.
[19] Stott DJ,Rodondi N,Kearney PM,et al.Thyroid hormone therapy for older adults with subclinical hypothyroidis[J].N Engl J Med,2017,376(26):2534-2544.DOI:10.1056/NEJMoa1603825.
[20] Jabbar A,Ingoe L,Junejo S,et al.Effect of levothyroxine on left ventricular ejection fraction in patients with subclinical hypothyroidism and acute myocardial infarction:a randomized clinical trial[J].JAMA,2020,324(3):249-258.DOI:10.1001/jama.2020.9389.
[21] Gencer B,Moutzouri E,Blum MR,et al.The impact of levothyroxine on cardiac function in older adults with mild subclinical hypothyroidism:a randomized clinical trial[J].Am J Med,2020,133(7):848-856.DOI:10.1016/j.amjmed.2020.01.018.
[22] Andersen MN,Olsen AS,Madsen JC,et al.Long-term outcome in levothyroxine treated patients with subclinical hypothyroidism and concomitant heart disease[J].J Clin Endocrinol Metab,2016,101(11):4170-4177.DOI:10.1210/jc.2016-2226.

备注/Memo

备注/Memo:
基金项目:2020年江苏省重点研发计划(BE2020726); 2021年江苏省老年健康科研项目(LK2021059)
通信作者:徐书杭,Email: shuhangxu@163.com; Email: 刘超,liuchao@nfmcn.com
更新日期/Last Update: 2023-12-30