McClelland P, Stott A, Howel-Evans W
Thyroid Clinic, Walton Hospital, Liverpool, UK.
Postgrad Med J. 1989 Apr;65(762):205-7. doi: 10.1136/pgmj.65.762.205.
During the follow-up of 224 cases of treated hypothyroidism, 14 clinically euthyroid patients were found to have elevated serum thyrotrophin and normal total thyroxine concentrations. Closer observation of these patients during the following 27 months resulted in the serum thyrotrophin levels returning to normal spontaneously in 8 patients (Group 1) whilst remaining elevated in 6 (Group 2), despite no significant differences in thyroid hormone levels between the two groups. Serum thyrotrophin in Group 2 patients remained high until an additional 50 micrograms/day thyroxine was prescribed although only 2 patients noted any benefit. Non-compliance or inadequate dosage of thyroxine are the probable causes of this sub-clinical hypothyroidism. Thyroid hormone estimations fail to differentiate the two conditions and we recommend a period of closer observation before making any thyroxine dosage adjustments in order to detect non-compliance.
在对224例接受治疗的甲状腺功能减退症患者的随访过程中，发现14例临床甲状腺功能正常的患者血清促甲状腺素升高而总甲状腺素浓度正常。在接下来的27个月里对这些患者进行密切观察，结果发现8例患者（第1组）的血清促甲状腺素水平自发恢复正常，而6例患者（第2组）的血清促甲状腺素水平仍居高不下，尽管两组之间的甲状腺激素水平无显著差异。第2组患者的血清促甲状腺素一直居高不下，直到额外开具每天50微克的甲状腺素处方，尽管只有2例患者表示有任何改善。甲状腺素服用不依从或剂量不足可能是这种亚临床甲状腺功能减退症的原因。甲状腺激素检测无法区分这两种情况，我们建议在进行任何甲状腺素剂量调整之前进行一段时间的密切观察，以发现服用不依从的情况。
