Bensenor Isabela
Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.
Sao Paulo Med J. 2002 Sep 2;120(5):146-51. doi: 10.1590/s1516-31802002000500005.
Advances in thyroid disorder diagnosis have created new thyroid disorder categories such as subclinical hyperthyroidism and subclinical hypothyroidism. In the 1980s, immunometric assaying for thyroid stimulating hormone (TSH) emerged and became defined as the most cost-effective test in thyroid disorder screening. The second step in the screening of thyroid disorders is to determine free thyroxine (FT4), and cost-effective methods for its detection are now available. Using TSH and FT4, it is possible to determine four situations: clinical hyperthyroidism, clinical hypothyroidism, subclinical hyperthyroidism and subclinical hypothyroidism. Subclinical hypothyroidism can be a strong indicator of risk for atherosclerosis and myocardial infarction in elderly women. Cardiovascular mortality among Brazilian women is one of the highest in the Western world. The best-known risk factors for cardiovascular diseases are high blood pressure, smoking, diabetes, and hypercholesterolemia. Although these are recognized as primary risk factors, there are other risk factors that could be identified as primordial risk factors. This may be the case for subclinical hypothyroidism. Early detection of thyroid disorders in women over fifty could be a highly cost-effective option in the prevention of cardiovascular disorders among Brazilian women.
甲状腺疾病诊断的进展产生了新的甲状腺疾病类别，如亚临床甲状腺功能亢进和亚临床甲状腺功能减退。20世纪80年代，甲状腺刺激激素（TSH）的免疫测定法出现，并被定义为甲状腺疾病筛查中最具成本效益的检测方法。甲状腺疾病筛查的第二步是测定游离甲状腺素（FT4），现在已有检测它的成本效益高的方法。使用TSH和FT4，可以确定四种情况：临床甲状腺功能亢进、临床甲状腺功能减退、亚临床甲状腺功能亢进和亚临床甲状腺功能减退。亚临床甲状腺功能减退可能是老年女性动脉粥样硬化和心肌梗死风险的有力指标。巴西女性的心血管死亡率是西方世界最高的之一。心血管疾病最知名的风险因素是高血压、吸烟、糖尿病和高胆固醇血症。虽然这些被认为是主要风险因素，但还有其他风险因素可被确定为原始风险因素。亚临床甲状腺功能减退可能就是这种情况。在50岁以上女性中早期发现甲状腺疾病可能是预防巴西女性心血管疾病的一个极具成本效益的选择。
