Bajaj Sarita, Sharma G P, Kumar D, Mehrotra R
Department of Medicine, MLN Medical College, Allahabad, UP.
J Assoc Physicians India. 2005 Jan;53:15-8.
To assess the significance of clinical versus biochemical diagnosis of hypothyroidism using a clinical scoring index and optimize the therapeutic dose of levothyroxine in Indian patients.
Three hundred and eighty eight cases of primary hypothyroidism (male:female ratio 1:5.8) were clinically classified as hypothyroid, euthyroid or inconclusive by Billewicz score. TSH estimation was repeated at 6-8 week intervals and appropriate adjustments in levothyroxine dosage made till the TSH was within the normal range.
Of 388 biochemically confirmed hypothyroid subjects less than one fourth (21.6%) could be classified as hypothyroid, almost one half were euthyroid (48.4%) and the remaining (29.9%) fell in the inconclusive category according to Billewiz score. Of 227 patients who returned for complete follow up there was a positive correlation of replacement dose with age and initial weight in females, but not in males. Baseline TSH values were not found to have a significant correlation with the initial dose. The mean replacement dose of levothyroxine (T4) in our subjects was 109.4 +/- 24.05 microg/d (range 1.25-3.84 microg/kg).
Clinical parameters alone fare poorly in establishing an unequivocal diagnosis of hypothyroidism. A biochemical confirmation is mandatory. The replacement done of T4 was found to be independent of the basal TSH level.
使用临床评分指数评估甲状腺功能减退症临床诊断与生化诊断的意义，并优化印度患者左甲状腺素的治疗剂量。
388例原发性甲状腺功能减退症患者（男女比例为1:5.8），根据比勒维茨评分在临床上分为甲状腺功能减退、甲状腺功能正常或不确定。每6 - 8周重复检测促甲状腺激素（TSH），并适当调整左甲状腺素剂量，直至TSH在正常范围内。
在388例经生化确诊的甲状腺功能减退患者中，根据比勒维茨评分，不到四分之一（21.6%）可被分类为甲状腺功能减退，近一半为甲状腺功能正常（48.4%），其余（29.9%）属于不确定类别。在227例返回进行完整随访的患者中，女性的替代剂量与年龄和初始体重呈正相关，但男性并非如此。未发现基线TSH值与初始剂量有显著相关性。我们研究对象中左甲状腺素（T4）的平均替代剂量为109.4 +/- 24.05微克/天（范围为1.25 - 3.84微克/千克）。
仅依靠临床参数在明确诊断甲状腺功能减退症方面效果不佳。必须进行生化确诊。发现T4的替代剂量与基础TSH水平无关。
