Wiersinga Wilmar M
Academisch Medisch Centrum, afd. Inwendige Geneeskunde - Endocrinologie en Metabolisme, Amsterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2012;156(49):A5477.
Recent meta-analyses of population-based studies with long-term follow-up have clarified the risk of cardiovascular disorders in patients with subclinical thyroid dysfunction. Subclinical hyperthyroidism is associated with an increased risk of atrial fibrillation and cardiovascular morbidity and mortality; the risk is higher at a thyroid stimulating hormone (TSH) level < 0.1 mU/l than at 0.1-0.4 mU/l. Subclinical hypothyroidism increases the risk of cardiovascular morbidity and mortality, especially at TSH levels >10 mU/l. The incidence of ischaemic heart disease is reduced upon treatment with levothyroxine sodium treatment in patients aged ≤ 70 years, but not in patients aged > 70 years. Despite the lack of randomised clinical trials providing evidence, treatment of subclinical hypothyroidism or hyperthyroidism is recommended when the TSH level is < 0.1 or > 10 mU/l. Treatment of patients with TSH levels between 0.1-0.4 mU/l or 4-10 mU/l should depend on other risk factors and patient age, with no treatment for persons with a TSH level of 4-10 mU/l who are older than 65 years.
近期对长期随访的人群研究进行的荟萃分析，已明确了亚临床甲状腺功能障碍患者发生心血管疾病的风险。亚临床甲状腺功能亢进与心房颤动以及心血管疾病的发病率和死亡率增加相关；在促甲状腺激素（TSH）水平<0.1 mU/L时的风险高于0.1 - 0.4 mU/L时。亚临床甲状腺功能减退会增加心血管疾病的发病率和死亡率，尤其是在TSH水平>10 mU/L时。≤70岁患者使用左甲状腺素钠治疗可降低缺血性心脏病的发病率，但>70岁患者则不然。尽管缺乏提供证据的随机临床试验，但当TSH水平<0.1或>10 mU/L时，建议对亚临床甲状腺功能减退或亢进进行治疗。TSH水平在0.1 - 0.4 mU/L或4 - 10 mU/L之间的患者的治疗应取决于其他风险因素和患者年龄，65岁以上TSH水平为4 - 10 mU/L的患者无需治疗。
