Goichot Bernard, Luca Florina
Hôpitaux universitaires de Strasbourg, service de médecine interne, endocrinologie et nutrition, hôpital de Hautepierre, 67098 Strasbourg cedex, France.
Presse Med. 2011 Dec;40(12 Pt 1):1132-40. doi: 10.1016/j.lpm.2011.09.009. Epub 2011 Nov 23.
Subclinical thyroid diseases are biologically defined: thyrotropin (TSH) decreased or increased with normal thyroid hormone concentrations. They are most often asymptomatics but carry a risk of long-term complications which can justify, in some cases, a treatment. The main complication of subclinical hyperthyroidism is atrial fibrillation, in particular after 60. Even if there is no controlled clinical trial available, treatment (usually with radioiodine) can be proposed to elderly subjects with autonomous thyroid disease (toxic adenoma or multinodular goitre) and TSH persistently below 0.1 mU/L. Subclinical hypothyroidism may be associated, particularly in subjects under 60, to a multifactorial increase of cardiovascular risk. An increase of TSH beyond 10 mU/L and positivity of antiTPO antibodies are the best predictors of the evolution toward overt hypothyroidism. In the elderly, there is no evidence of a risk associated with moderately increased TSH and treatment is probably not justified in most cases.
促甲状腺激素（TSH）降低或升高，而甲状腺激素浓度正常。它们通常无症状，但存在长期并发症风险，在某些情况下这种风险可成为治疗的依据。亚临床甲状腺功能亢进的主要并发症是心房颤动，尤其是60岁以后。即使没有对照临床试验，对于患有自主性甲状腺疾病（毒性腺瘤或多结节性甲状腺肿）且TSH持续低于0.1 mU/L的老年患者，也可建议进行治疗（通常采用放射性碘治疗）。亚临床甲状腺功能减退可能与心血管风险的多因素增加有关，尤其是在60岁以下的人群中。TSH升高超过10 mU/L以及抗甲状腺过氧化物酶抗体阳性是发展为显性甲状腺功能减退的最佳预测指标。在老年人中，没有证据表明TSH适度升高会带来风险，在大多数情况下可能无需治疗。
