Division of Endocrinology and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Lancet. 2012 Mar 24;379(9821):1142-54. doi: 10.1016/S0140-6736(11)60276-6. Epub 2012 Jan 23.
Subclinical thyroid diseases--subclinical hyperthyroidism and subclinical hypothyroidism--are common clinical entities that encompass mild degrees of thyroid dysfunction. The clinical significance of mild thyroid overactivity and underactivity is uncertain, which has led to controversy over the appropriateness of diagnostic testing and possible treatment. In this Seminar, we discuss the definition, epidemiology, differential diagnoses, risks of progression to overt thyroid disease, potential effects on various health outcomes, and management of subclinical hyperthyroidism and subclinical hypothyroidism. Treatment recommendations are based on the degree to which thyroid-stimulating hormone concentrations have deviated from normal and underlying comorbidities. Large-scale randomised trials are urgently needed to inform how to best care for individuals with subclinical thyroid disease.
亚临床甲状腺疾病——亚临床甲状腺功能亢进症和亚临床甲状腺功能减退症——是常见的临床病症，包括轻度甲状腺功能障碍。轻度甲状腺功能亢进和功能减退的临床意义尚不确定，这导致了对诊断检测和可能治疗的适当性的争议。在本次研讨会上，我们讨论了亚临床甲状腺功能亢进症和亚临床甲状腺功能减退症的定义、流行病学、鉴别诊断、进展为显性甲状腺疾病的风险、对各种健康结果的潜在影响以及管理。治疗建议基于促甲状腺激素浓度偏离正常的程度和潜在的合并症。迫切需要大规模的随机试验来告知如何最好地照顾亚临床甲状腺疾病患者。
