Department of Clinical and Molecular Endocrinology and Oncology, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy.
Best Pract Res Clin Endocrinol Metab. 2012 Aug;26(4):431-46. doi: 10.1016/j.beem.2011.12.004. Epub 2012 May 22.
Subclinical thyroid dysfunction (STD) represents a condition of slight thyroid hormone excess or deficiency, which may be associated with important adverse effects. This review will focus on the natural history, diagnosis and management of subclinical thyroid dysfunction. Since STD is only detected as a thyroid stimulating hormone (TSH) abnormality, it is essential to exclude transient causes of abnormal serum TSH before treating this disorder. Treatment of subclinical hyperthyroidism (SHyper) is recommended in elderly patients with undetectable serum TSH for the increased risk of atrial fibrillation, osteoporosis and bone fractures and for the higher risk of progression to overt disease. Treatment of subclinical hypothyroidism should be considered in patients with serum TSH above 10 mU/L for the increased risk of progression to overt hypothyroidism and the increased risk of coronary heart disease and heart failure events, which have been documented in patients with TSH increase above 10 mU/L. About 75% of patients with STD have mild dysfunction. The mild form of STD (low but detectable serum TSH in SHyper and mild increased serum TSH between 5 and 9 mU/L in SHypo is associated with a minor risk of disease progression to overt dysfunction. The best treatment for STD remains controversial. Treatment of the mild form of STD should be considered after evaluating the patients' age, the adverse risk factors, the potential beneficial effects of treating this disorder and any underlying co-morbidities. Mild SHypo should be treated in infertile and pregnant women.
亚临床甲状腺功能障碍（STD）是指甲状腺激素轻微过多或不足的状态，可能与重要的不良后果有关。本篇综述将聚焦于亚临床甲状腺功能障碍的自然病程、诊断和治疗。由于 STD 仅表现为促甲状腺激素（TSH）异常，因此在治疗这种疾病之前，必须排除 TSH 血清异常的一过性原因。对于血清 TSH 持续不可检测的老年患者，亚临床甲亢（SHyper）建议治疗，因为其发生房颤、骨质疏松和骨折的风险增加，且向显性疾病进展的风险较高。对于血清 TSH 高于 10 mU/L 的患者，建议考虑治疗亚临床甲状腺功能减退症，因为其发生显性甲状腺功能减退症的风险增加，且发生冠心病和心力衰竭事件的风险也增加，TSH 高于 10 mU/L 的患者已经出现这些风险。约 75%的 STD 患者存在轻度功能障碍。轻度 STD（SHyper 时 TSH 轻度降低但可检测，SHypo 时 TSH 在 5-9 mU/L 之间轻度升高）与疾病向显性功能障碍进展的风险增加相关，但风险较小。STD 的最佳治疗方法仍存在争议。应在评估患者年龄、不良风险因素、治疗该疾病的潜在益处和任何潜在的合并症后，考虑对轻度 STD 进行治疗。不孕和孕妇的轻度 SHypo 应进行治疗。
