Graduate Entry Medical School, Clinical Academic Liaison Building, University of Limerick, University Hospital, Dooradoyle Campus, Limerick, Ireland,
Ir J Med Sci. 2014 Mar;183(1):1-6. doi: 10.1007/s11845-013-0994-y. Epub 2013 Aug 10.
This article is an evidence-based review of thyroid disease in children with Down syndrome, including a comparison between various professional guidelines for the management of thyroid disease in children with Down syndrome. Aspects of thyroid disease which are discussed include: congenital hypothyroidism; autoimmune thyroid disease; subclinical hypothyroidism; and hyperthyroidism. The national professional guidelines of Ireland, the United Kingdom, the United States of America, Australia and Canada are reviewed and compared.
A literature search was conducted using Medline and PubMed. Search terms included 'Down syndrome' and 'thyroid disease', 'hypothyroidism', 'hyperthyroidism', 'subclinical hypothyroidism'.
Eighty-nine articles were retrieved and reviewed for inclusion. The guidelines on the medical management of children with Down syndrome of five expert groups have also been retrieved and reviewed for this discussion. These various guidelines offer largely similar advice regarding frequency of thyroid function tests, with only Ireland and the UK testing less frequently than annually. Only the United Kingdom and Irish Down Syndrome Medical Interest Group guidelines suggest testing for thyroid antibodies at every thyroid screen. None of the guidelines offer suggestions on the optimal course of action to pursue after the discovery of subclinical hypothyroidism.
In conclusion, more evidence is required regarding the optimal course of treatment for subclinical hypothyroidism. Such evidence may be best obtained by conducting a prospective randomized control trial.
本文是一篇基于证据的综述，内容涉及唐氏综合征患儿甲状腺疾病，包括对不同专业指南中唐氏综合征患儿甲状腺疾病管理方法的比较。本文所讨论的甲状腺疾病方面包括：先天性甲状腺功能减退症；自身免疫性甲状腺疾病；亚临床甲状腺功能减退症；甲状腺功能亢进症。本文对爱尔兰、英国、美国、澳大利亚和加拿大的国家专业指南进行了回顾和比较。
通过 Medline 和 PubMed 进行文献检索。检索词包括“唐氏综合征”和“甲状腺疾病”、“甲状腺功能减退症”、“甲状腺功能亢进症”、“亚临床甲状腺功能减退症”。
共检索到 89 篇文章，并对其进行了纳入分析。还检索并回顾了五个专家组关于唐氏综合征患儿医学管理的指南，以进行本讨论。这些不同的指南在甲状腺功能检测频率方面提供了大致相似的建议，只有爱尔兰和英国的检测频率低于每年一次。只有英国和爱尔兰唐氏综合征医学兴趣小组的指南建议在每次甲状腺筛查时检测甲状腺抗体。没有任何指南提供关于发现亚临床甲状腺功能减退症后最佳治疗方案的建议。
综上所述，需要更多关于亚临床甲状腺功能减退症最佳治疗方案的证据。此类证据可能最好通过进行前瞻性随机对照试验来获得。
