老年人亚临床甲状腺功能减退诊断和治疗中的困惑

Puzzle in the diagnosis and treatment of subclinical hypothyroidism in the elderly

亚临床甲状腺功能减退（甲减）是一种实验室诊断,定义为血清TSH水平高于正常参考范围上限,FT4水平正常.甲状腺功能改变与年龄增长相关,现有的研究均显示随着年龄的增长,亚临床甲减患病率增加,女性更为明显.但是随着年龄增长,血清TSH水平升高,所以有研究建议老年人血清TSH的参考范围应放宽.正因如此,老年人亚临床甲减治疗时机及治疗目标争论最多.目前建议老年人亚临床甲减,当TSH≥10 mIU/L时考虑左旋甲状腺素治疗;当TSH介于正常参考值上限和10 mIU/L之间,结合患者症状、是否有心血管疾病史以及患病危险因素决定是否治疗.治疗的目标根据患者的年龄和心脏等情况个体化制定.

Based on laboratory tests,subclinical hypothyroidism is diagnosed and defined as an elevated serum TSH concentration with FT4 within reference range.Alterations in thyroid function are associated with aging.All available studies show that prevalence of subclinical hypothyroidism increases with aging,especially in women.However,some studies advise that serum TSH reference range for older people should be modified,because serum TSH elevates with aging.Therefore,when to and how to treat subclinical hypothyroidism in the elderly has been debating fiercely.At present,levothyroxine sodium treatment is generally recommended when TSH is raised more than 10 mIU/L.When TSH level is between the upper limit of the reference range and 10 mIU/L,treatment should depend on symptoms,history and risk factors of cardiovascular disease.Therapeutic objective should be individualized,depending on age,cardiac function,and other conditions.