Ayala A R, Danese M D, Ladenson P W
Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Endocrinol Metab Clin North Am. 2000 Jun;29(2):399-415. doi: 10.1016/s0889-8529(05)70139-0.
The availability and wide acceptance of TSH assays for primary assessment of thyroid function has led to the recognition that mild thyroid hormone deficiency is characterized by elevation of the serum TSH concentration despite a normal free thyroxine level. Other conditions can also cause isolated serum TSH elevation, and these conditions can be distinguished from mild thyroid failure usually based-on clinical and circumstantial observations alone. Thyroxine treatment of patients with mild hypothyroidism has been shown in most, but not all, clinical trials to lower atherogenic lipid levels and relieve certain somatic and neuropsychiatric symptoms. Such treatment also prevents the progression to overt hypothyroidism, which is particularly likely in patients who are older, who have circulating thyroid autoantibodies, or who have a serum TSH greater than 10 mU/L. After the optimal thyroxine dose has been defined, long-term monitoring of patients with an annual clinical evaluation and serum TSH measurement is appropriate. The high prevalence of mild hypothyroidism, particularly in older women, and its subtle clinical presentation have led some authorities to recommend a low threshold for case-finding or routine population screening for the disorder.
促甲状腺激素（TSH）检测方法可用于甲状腺功能的初步评估，且已被广泛接受，这使得人们认识到，即使游离甲状腺素水平正常，轻度甲状腺激素缺乏的特征也是血清TSH浓度升高。其他情况也可导致血清TSH单独升高，通常仅根据临床和相关观察就能将这些情况与轻度甲状腺功能减退区分开来。在大多数（但并非所有）临床试验中，已证明对轻度甲状腺功能减退患者进行甲状腺素治疗可降低致动脉粥样硬化的血脂水平，并缓解某些躯体和神经精神症状。这种治疗还可防止发展为明显的甲状腺功能减退，这在年龄较大、有循环甲状腺自身抗体或血清TSH大于10 mU/L的患者中尤其可能发生。确定最佳甲状腺素剂量后，每年进行临床评估和血清TSH检测对患者进行长期监测是合适的。轻度甲状腺功能减退的高患病率，尤其是在老年女性中，及其隐匿的临床表现，使得一些权威机构建议对该疾病进行低阈值的病例发现或常规人群筛查。
