老年甲状腺功能亢进症的管理

Management of hyperthyroidism in the elderly.

近年来随着生育率下降和预期寿命延长,中国老年人口占比急剧增加。甲状腺功能亢进症(甲亢)作为常见的内分泌疾病,在老年人群中并不少见。碘充足地区老年甲亢以Graves病(Graves’disease,GD)为主,碘缺乏地区则以毒性多结节性甲状腺肿(toxic multinodular goiter,TMNG)更常见。老年甲亢起病隐袭,缺乏典型高代谢症候群,常以心血管相关症状为首发和主要表现,部分因缺乏典型症状和体征,易与神经衰弱或衰老表现混淆导致漏诊和误诊。老年甲亢的治疗策略取决于病因和风险,有些患者可能需要长期使用抗甲状腺药物治疗,放射性131碘治疗则是部分患者更方便有效的选择。

With a low fertility rate and increased life expectancy,China is facing a rapidly ageing population.Hyperthyroidism is a common endocrine disease in the elderly.While Graves’disease is the most common type of hyperthyroidism in eldely patients in iodine-replete areas,toxic multinodular goiter is relatively more common in iodinedeficient areas.The clinical manifestations of hyperthyroidism in the elderly are often atypical and can easily be attributed to other medical conditions or‘normal aging’.In elder patients signs and symptoms of thyrotoxicosis are frequently related to cardiovascular disorders.The decision to treat and the nature of the treatment depend on the causes of the disease and coexisting conditions.Long-term use of antithyroid drugs is the preferred treatment in some patients with Graves’disease,whereas radioiodine is more convenient and effective for some patients.