Pearce Elizabeth N
Boston University Medical Center, 88 East Newton Street, Boston, MA 02118, USA.
Menopause Int. 2007 Mar;13(1):8-13. doi: 10.1258/175404507780456746.
Thyroid dysfunction is common, especially among women over the age of 50. In caring for peri- and post-menopausal women, it is important to recognize the changing clinical manifestations of thyroid disease with age. Postmenopausal women are at increased risk of both osteoporosis and cardiovascular disease, and untreated thyroid disease may exacerbate these risks. Screening for thyroid dysfunction in asymptomatic individuals is controversial, but aggressive case-finding should be pursued, especially in older women. Women with overt thyroid dysfunction should be treated. Therapy for women with subclinical thyroid dysfunction is more controversial, although women with levels of thyroid stimulating hormone (TSH) > or =10 mU/L should be treated, and treatment may be considered in symptomatic women with subclinical hypothyroidism and TSH values <10 mU/L, and in women with subclinical hyperthyroidism who have TSH values consistently <0.1 mU/L. In women who are treated with thyroxine, careful dose titration and monitoring are required in order to prevent the adverse consequences of iatrogenic subclinical hyperthyroidism or hypothyroidism. Finally, caution is required in diagnosing and treating thyroid dysfunction in women who are taking oral estrogens or selective estrogen receptor modulators.
甲状腺功能障碍很常见，尤其是在50岁以上的女性中。在护理围绝经期和绝经后女性时，认识到甲状腺疾病的临床表现随年龄变化很重要。绝经后女性患骨质疏松症和心血管疾病的风险增加，未经治疗的甲状腺疾病可能会加剧这些风险。对无症状个体进行甲状腺功能障碍筛查存在争议，但应积极进行病例发现，尤其是在老年女性中。明显甲状腺功能障碍的女性应接受治疗。亚临床甲状腺功能障碍女性的治疗更具争议性，尽管促甲状腺激素（TSH）水平≥10 mU/L的女性应接受治疗，对于有症状的亚临床甲状腺功能减退且TSH值<10 mU/L的女性以及TSH值持续<0.1 mU/L的亚临床甲状腺功能亢进女性，也可考虑治疗。在用甲状腺素治疗的女性中，需要仔细进行剂量滴定和监测，以预防医源性亚临床甲状腺功能亢进或甲状腺功能减退的不良后果。最后，在诊断和治疗正在服用口服雌激素或选择性雌激素受体调节剂的女性的甲状腺功能障碍时需要谨慎。
