Evans Timothy C
Department of Medicine, University of Washington School of Medicine, Seattle, WA 98105, USA.
Prim Care. 2003 Dec;30(4):625-40. doi: 10.1016/s0095-4543(03)00087-3.
Evaluation and treatment of thyroid disease is a common feature of primary care medicine. Nevertheless, the dose of thyroid hormone used to treat hypothyroidism is frequently not titrated to normalize the TSH, engendering the risks of under- or overtreatment. Other hypothyroid patients remain symptomatic even with normalized TSH on levothyroxine alone. Some of these patients improve symptomatically when liothyronine is added to the treatment regimen. Subclinical hypothyroidism and hyperthyroidism are also relatively common in primary care medical practice, and appropriately selected patients probably benefit from treatment. In the follow-up of patients treated for thyroid cancer, the use of rhTSH improves patient comfort considerably while allowing sensitive screening for persistent or recurrent cancer.
甲状腺疾病的评估与治疗是初级保健医学的常见内容。然而，用于治疗甲状腺功能减退症的甲状腺激素剂量常常未进行调整以使促甲状腺激素（TSH）恢复正常，从而产生治疗不足或过度治疗的风险。其他甲状腺功能减退症患者即使仅使用左甲状腺素使TSH恢复正常，仍有症状。其中一些患者在治疗方案中添加三碘甲状腺原氨酸后症状有所改善。亚临床甲状腺功能减退症和甲状腺功能亢进症在初级保健医疗实践中也相对常见，适当选择的患者可能从治疗中获益。在接受甲状腺癌治疗的患者随访中，使用重组人促甲状腺激素（rhTSH）可显著提高患者的舒适度，同时便于对持续性或复发性癌症进行敏感筛查。
