Gurevitz Samuel L, Snyder Jennifer A, Peterson Katie L, Kelly Kristin L
College of Pharmacy and Health Sciences, Butler University, Indianapolis, Indiana.
Consult Pharm. 2011 Sep;26(9):657-64. doi: 10.4140/TCP.n.2011.657.
To review the etiology, precipitating factors, clinical findings, screening recommendations, and treatment for primary hypothyroidism and subclinical hypothyroidism in the older patient.
A PubMed search of English language articles using a combination of words: elderly, thyroid, hypothyroid,* subclinical hypothyroid,* etiology, screening, diagnosis, and treatment to identify original studies, guidelines, and reviews on primary hypothyroidism and subclinical hypothyroidism published between 1979 and present.
Overall, 51 clinical reviews, original studies, references, and guidelines were obtained and evaluated on their clinical relevance to the older patient population.
The literature included guidelines and considerations for the diagnosis, screening, and management of subclinical and overt primary hypothyroidism in the older patient.
Females and individuals 60 years of age or older have a higher prevalence of primary hypothyroidism and subclinical hypothyroidism. While screening recommendations exist, the need or suggested age to initiate screening varies among organizations. TSH and free T4 values are used for diagnosing and monitoring. Levothyroxine remains the drug of choice for replacing endogenous thyroid hormone. Despite evidence to suggest its need, the treatment of subclinical hypothyroidism remains controversial.
回顾老年患者原发性甲状腺功能减退症和亚临床甲状腺功能减退症的病因、诱发因素、临床表现、筛查建议及治疗方法。
通过在PubMed上搜索英文文章，使用以下组合词：老年人、甲状腺、甲状腺功能减退、亚临床甲状腺功能减退、病因、筛查、诊断和治疗，以识别1979年至今发表的关于原发性甲状腺功能减退症和亚临床甲状腺功能减退症的原始研究、指南和综述。
共获得51篇临床综述、原始研究、参考文献和指南，并对其与老年患者群体的临床相关性进行了评估。
文献包括老年患者亚临床和显性原发性甲状腺功能减退症的诊断、筛查和管理指南及注意事项。
女性及60岁及以上人群原发性甲状腺功能减退症和亚临床甲状腺功能减退症的患病率较高。虽然存在筛查建议，但各组织开始筛查的必要性或建议年龄各不相同。促甲状腺激素（TSH）和游离甲状腺素（FT4）值用于诊断和监测。左甲状腺素仍然是替代内源性甲状腺激素的首选药物。尽管有证据表明需要治疗，但亚临床甲状腺功能减退症的治疗仍存在争议。
