Sawin C T, Geller A, Hershman J M, Castelli W, Bacharach P
Medical Service, Boston Veterans Administration Medical Center, MA 02130.
JAMA. 1989 May 12;261(18):2653-5. doi: 10.1001/jama.261.18.2653.
The overall prevalence of thyroid hormone use in an unselected population of older adults (n = 2575; average age, 68.6 years) was 6.9% (10.0% in women and 2.3% in men). Eighty-one percent of women taking it were doing so for appropriate indications, eg, hypothyroidism, while 12% were not, eg, for obesity or high serum cholesterol; more men (29%) were taking it inappropriately. Inappropriate use was associated with desiccated thyroid more than with thyroxine. After follow-up averaging 6.9 years, 58% of inappropriate users were still taking it. Underuse also occurred. Thirty-seven percent of those definitely hypothyroid had a clearly elevated serum thyrotropin level (greater than 10 mU/L) despite thyroid therapy. Thyroid therapy is common in the elderly; most is appropriate. When inappropriate use occurs, it is more common in men and more often associated with desiccated thyroid, still commonly used in this age group. In chronic users of thyroid hormone, it is important to review currently appropriate indications and to measure serum thyrotropin levels to assess the adequacy of treatment of primary hypothyroidism.
在一个未经过挑选的老年人群体（n = 2575；平均年龄68.6岁）中，甲状腺激素的总体使用率为6.9%（女性为10.0%，男性为2.3%）。服用甲状腺激素的女性中，81%是出于适当的适应症，如甲状腺功能减退，而12%并非如此，如用于肥胖或高血清胆固醇；男性中不适当服用的比例更高（29%）。与甲状腺素相比，不适当使用与甲状腺干制剂的关联更大。经过平均6.9年的随访，58%的不适当使用者仍在服用。甲状腺激素使用不足的情况也存在。37%明确患有甲状腺功能减退的患者尽管接受了甲状腺治疗，但血清促甲状腺素水平仍明显升高（大于10 mU/L）。甲状腺治疗在老年人中很常见；大多数是适当的。当出现不适当使用时，在男性中更常见，并且更常与甲状腺干制剂相关，而甲状腺干制剂在这个年龄组中仍被普遍使用。对于长期使用甲状腺激素的患者，重要的是复查当前适当的适应症，并检测血清促甲状腺素水平，以评估原发性甲状腺功能减退的治疗是否充分。
