[1]张小改 徐书杭 陈国芳 刘超.轻度亚临床甲状腺功能减退症是否需要干预: 基于循证医学的思考[J].国际内分泌代谢杂志,2018,38(06):386-389393.[doi:10.3760/cma.j.issn.1673-4157.2018.06.006]
　Zhang Xiaogai,Xu Shuhang,Chen Guofang,et al.Is interventional therapy in mild subclinical hypothyroidism necessary: thoughts based on evidence[J].International Journal of Endocrinology and Metabolism,2018,38(06):386-389393.[doi:10.3760/cma.j.issn.1673-4157.2018.06.006]
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轻度亚临床甲状腺功能减退症是否需要干预: 基于循证医学的思考()
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《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
38
期数:
2018年06期
页码:
386-389393
栏目:
综述
出版日期:
2018-11-20

文章信息/Info

Title:
Is interventional therapy in mild subclinical hypothyroidism necessary: thoughts based on evidence
作者:
张小改 徐书杭 陈国芳 刘超
作者单位:210028 南京中医药大学附属中西医结合医院(江苏省中医药研究院)内分泌科
Author(s):
Zhang Xiaogai;  Xu Shuhang;  Chen Guofang;  Liu Chao
Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing 210028, China
关键词:
亚临床甲状腺功能减退症;  左甲状腺素;  替代治疗
Keywords:
Subclinical hypothyroidism;  Levothyroxine;  Replacement therapy
DOI:
10.3760/cma.j.issn.1673-4157.2018.06.006
摘要:
亚临床甲状腺功能减退症(SCH)是较为常见的临床疾病,女性发病率大于男性,并随着年龄和促甲状腺激素水平的升高进一步增加。既往的研究发现,即使轻度SCH亦会增加心血管疾病、代谢性疾病和不良妊娠结局等的风险,并且替代治疗可使整体健康获益。但轻度SCH与骨骼肌系统、认知功能异常、情绪障碍、血脂紊乱和糖尿病等之间的联系及其治疗的临床获益仍存在争议。
Abstract:
Subclinical hypothyroidism(SCH)is a common problem(prevalence is greater in women than men), which increases further with increasing age and thyroid stimulating hormone level. Previous studies suggested that even though mild-SCH had a detrimental effect on cardiovascular risk factors and metabolic diseases, and increased risk of adverse pregnancy outcomes, and that its effective treatment might have a beneficial impact on overall health. However, evidence on the association of mild-SCH and musculoskeletal system, cognitive dysfunction, mood disorders, dyslipidaemia, and diabetes, and the clinical benefits of treatment are controversial.

参考文献/References:


[1] Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA Guideline:management of subclinical hypothyroidism[J].Eur Thyroid J,2013,2(4):215-228. DOI:10.1159/000356507.
[2] Sun J,Yao L,Fang Y,et al.Relationship between subclinical thyroid dysfunction and the risk of cardiovascular outcomes: a systematic review and meta-analysis of prospective cohort studies[J].Int J Endocrinol,2017,2017:8130796. DOI:10.1155/2017/8130796.
[3] Baumgartner C,Blum MR,Rodondi N.Subclinical hypothyroidism: summary of evidence in 2014[J].Swiss Med Wkly,2014,144:w14058. DOI:10.4414/smw.2014.14058.
[4] Gao N, Zhang W, Zhang YZ,et al. Carotid intima-media thickness in patients with subclinical hypothyroidism: a meta-analysis[J].Atherosclerosis,2013,227(1):18-25. DOI:10.1016/j.atherosclerosis.2012.10.070.
[5] Zhao M,Yang T,Chen L,et al.Subclinical hypothyroidism might worsen the effects of aging on serum lipid profiles: a population-based case-control study[J].Thyroid,2015,25(5):485-493. DOI:10.1089/thy.2014.0219.
[6] Geng H,Zhang X,Wang C,et al.Even mildly elevated TSH is associated with an atherogenic lipid profile in postmenopausal women with subclinical hypothyroidism[J].Endocr Res,2015,40(1):1-7. DOI:10.3109/07435800.2013.879166.
[7] Huang R,Zheng J,Li S,et al.Subclinical hypothyroidism in patients with polycystic ovary syndrome: distribution and its association with lipid profiles[J].Eur J Obstet Gynecol Reprod Biol,2014,177:52-56.DOI:10.1016/j.ejogrb.2014.04.013.
[8] Kitahara CM,Platz EA,Ladenson PW,et al.Body fatness and markers of thyroid function among U.S. men and women[J].PLoS One,2012,7(4):e34979.DOI:10.1371/journal.pone.0034979.
[9] Triolo TM,Armstrong TK,McFann K,et al.Additional autoimmune disease found in 33% of patients at type 1 diabetes onset[J].Diabetes Care,2011,34(5):1211-1213. DOI:10.2337/dc10-1756.
[10] Kahaly GJ.Polyglandular autoimmune syndrome type Ⅱ[J].Presse Med,2012,41(12 P 2):e663-e670.DOI:10.1016/j.lpm.2012.09.011.
[11] Han C,He X,Xia X,et al. Subclinical hypothyroidism and type 2 diabetes: a systematic review and meta-analysis[J].PLoS One,2015,10(8):e0135233.DOI:10.1371/journal.pone.0135233.
[12] Xu L,Ma H,Miao M,et al.Impact of subclinical hypothyroidism on the development of non-alcoholic fatty liver disease: a prospective case-control study[J].J Hepatol,2012,57(5):1153-1154. DOI:10.1016/j.jhep.2012.05.025.
[13] Jaruvongvanich V,Sanguankeo A,Upala S.Nonalcoholic fatty liver disease is not associated with thyroid hormone levels and hypothyroidism: a systematic review and meta-analysis[J].Eur Thyroid J,2017,6(4):208-215.DOI:10.1159/000454920.
[14] Lankhaar JA,de Vries WR,Jansen JA,et al.Impact of overt and subclinical hypothyroidism on exercise tolerance: a systematic review[J].Res Q Exerc Sport,2014,85(3):365-389.DOI:10.1080/02701367.2014.930405.
[15] Virgini VS,Wijsman LW,Rodondi N,et al. Subclinical thyroid dysfunction and functional capacity among elderly[J].Thyroid,2014,24(2):208-214. DOI:10.1089/thy.2013.0071.
[16] Tudela CM,Casey BM,McIntire DD,et al.Relationship of subclinical thyroid disease to the incidence of gestational diabetes[J].Obstet Gynecol,2012,119(5):983-988.DOI:10.1097/AOG.0b013e318250aeeb.
[17] Toulis KA,Stagnaro-Green A,Negro R.Maternal subclinical hypothyroidism and gestational diabetes mellitus: a meta-analysis[J].Endocr Pract,2014,20(7):703-714.DOI:10.4158/EP13440.RA.
[18] Maraka S,Ospina NM,O'Keeffe DT,et al.Subclinical hypothyroidism in pregnancy: a systematic review and meta-analysis[J].Thyroid,2016,26(4):580-590.DOI:10.1089/thy.2015.0418.
[19] Lazarus J,Brown RS,Daumerie C,et al.2014 European thyroid association guidelines for the management of subclinical hypothyroidism in pregnancy and in children[J].Eur Thyroid J,2014,3(2):76-94.DOI:10.1159/000362597.
[20] Su PY,Huang K,Hao JH,et al.Maternal thyroid function in the first twenty weeks of pregnancy and subsequent fetal and infant development: a prospective population-based cohort study in China[J].J Clin Endocrinol Metab,2011,96(10):3234-3241.DOI:10.1210/jc.2011-0274.
[21] Razvi S,Weaver JU,Butler TJ,et al.Levothyroxine treatment of subclinical hypothyroidism, fatal and nonfatal cardiovascular events, and mortality[J].Arch Intern Med,2012,172(10):811-817. DOI:10.1001/archinternmed.2012.1159.
[22] Andersen MN,Olsen AM,Madsen JC,et al.Levothyroxine substitution in patients with subclinical hypothyroidism and the risk of myocardial infarction and mortality[J].PLoS One,2015,10(6):e0129793.DOI:10.1371/journal.pone.0129793.
[23] Grossman A,Feldhamer I,Meyerovitch J.Treatment with levothyroxin in subclinical hypothyroidism is associated with increased mortality in the elderly[J].Eur J Intern Med,2018,50:65-68. DOI:10.1016/j.ejim.2017.11.010.
[24] Abreu IM,Lau E,de Sousa Pinto B,et al.Subclinical hypothyroidism: to treat or not to treat, that is the question! A systematic review with meta-analysis on lipid profile[J].Endocr Connect,2017,6(3):188-199.DOI:10.1530/EC-17-0028.
[25] Zhao T,Chen B,Zhou Y,et al.Effect of levothyroxine on the progression of carotid intima-media thickness in subclinical hypothyroidism patients: a meta-analysis[J].BMJ Open,2017,7(10):e016053. DOI:10.1136/bmjopen-2017-016053.
[26] 中华医学会内分泌学分会.成人甲状腺功能减退症诊治指南[J].中华内分泌代谢杂志, 2017,33(2):167-180. DOI:10.3760/cma.j.issn.1000-6699.2017.02.018.
[27] Liu L,Yu Y,Zhao M,et al.Benefits of levothyroxine replacement therapy on nonalcoholic fatty liver disease in subclinical hypothyroidism patients[J].Int J Endocrinol,2017,2017:5753039.DOI:10.1155/2017/5753039.
[28] Li X,Zhen D,Zhao M,et al.Natural history of mild subclinical hypothyroidism in a middle-aged and elderly Chinese population: a prospective study[J].Endocr J,2017,64(4):437-447. DOI:10.1507/endocrj.EJ16-0549.
[29] Pandrc MS,Risti A,Kostovski V,et al.The effect of early substitution of subclinical hypothyroidism on biochemical blood parameters and the quality of life[J].J Med Biochem,2017,36(2):127-136.DOI:10.1515/jomb-2017-0007.
[30] Aghili R,Khamseh ME,Malek M,et al.Changes of subtests of Wechsler Memory Scale and cognitive function in subjects with subclinical hypothyroidism following treatment with levothyroxine[J].Arch Med Sci,2012,8(6):1096-1101. DOI:10.5114/aoms.2012.32423.
[31] Parsaik AK,Singh B,Roberts RO,et al.Hypothyroidism and risk of mild cognitive impairment in elderly persons: a population-based study[J].JAMA Neurol,2014,71(2):201-207.DOI:10.1001/jamaneurol.2013.5402.
[32] Wijsman LW,de Craen AJ,Trompet S,et al. Subclinical thyroid dysfunction and cognitive decline in old age[J].PLoS One,2013,8(3):e59199. DOI:10.1371/journal.pone.0059199.
[33] Stott DJ,Rodondi N,Kearney PM,et al.Thyroid hormone therapy for older adults with subclinical hypothyroidism[J].N Engl J Med,2017,376(26):2534-2544. DOI:10.1056/NEJMoa1603825.
[34] Casey BM,Thom EA,Peaceman AM,et al.Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy[J].N Engl J Med,2017,376(9):815-825. DOI:10.1056/NEJMoa1606205.
[35] Behrooz HG,Tohidi M,Mehrabi Y,et al.Subclinical hypothyroidism in pregnancy: intellectual development of offspring[J].Thyroid,2011,21(10):1143-1147. DOI:10.1089/thy.2011.0053.
[36] Maraka S,Mwangi R,McCoy RG,et al.Thyroid hormone treatment among pregnant women with subclinical hypothyroidism:US national assessment[J].BMJ,2017,356:i6865.DOI:10.1136/bmj.i6865.
[37] Alexander EK,Pearce EN,Brent GA,et al.2017 Guidelines of the American thyroid association for the diagnosis and management of thyroid disease during pregnancy and the postpartum[J].Thyroid,2017,27(3):315-389. DOI:10.1089/thy.2016.0457.
[38] Wang H,Gao H,Chi H,et al.Effect of levothyroxine on miscarriage among women with normal thyroid function and thyroid autoimmunity undergoing in vitro fertilization and embryo transfer: a randomized clinical trial[J].JAMA,2017,318(22):2190-2198. DOI:10.1001/jama.2017.18249.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金(81200577); 江苏省“六大人才高峰”项目(2013-WSN-063); 江苏省临床医学科技专项-重点病种的规范化诊疗(BL2013040)
Fund program:National Natural Science Foundation of China(81200577); "Six Talents Peak" Project of Jiangsu Province(2013-WSN-063); Specialized Diagnosis and Treat
更新日期/Last Update: 2018-12-30