Fatourechi Mitra M, Fatourechi Vahab
a PO Box, 6107, Irvine, CA 92616, USA.
b Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
Expert Rev Endocrinol Metab. 2014 Mar;9(2):137-151. doi: 10.1586/17446651.2014.887433. Epub 2014 Feb 18.
Subclinical thyroid dysfunction is characterized by normal levels of peripheral thyroid hormone, paired with a TSH level that is either lower than (subclinical hyperthyroidism) or higher than (subclinical hypothyroidism) the normal laboratory reference range. Slight shifts in peripheral hormone levels result in significant serum TSH changes. The exact upper limit of normal TSH and the management of subclinical hypothyroidism are still controversial. For those with TSH between high upper limit of normal and 10 mIU/L, the authors suggest selective use of thyroxine therapy. The authors agree with the general consensus in favor of therapy for those with serum TSH levels above 10 mIU/L. This recommendation is compatible with guidelines of American Thyroid Association and American Association of Clinical Endocrinologists. For subclinical hyperthyroidism persistent serum TSH <0.1 mIU/L should be treated particularly if the etiology is nodular toxic goiter. For serum TSH between 0.1 mIU/L and lower limit of normal, serum TSH co-morbidities such as cardiac risk factors and osteoporosis may favor therapy.
亚临床甲状腺功能障碍的特征是外周甲状腺激素水平正常，同时促甲状腺激素（TSH）水平低于（亚临床甲状腺功能亢进）或高于（亚临床甲状腺功能减退）正常实验室参考范围。外周激素水平的轻微变化会导致血清TSH显著改变。正常TSH的确切上限以及亚临床甲状腺功能减退的管理仍存在争议。对于TSH处于正常上限较高值与10 mIU/L之间的患者，作者建议选择性使用甲状腺素治疗。作者同意对于血清TSH水平高于10 mIU/L的患者进行治疗的普遍共识。该建议与美国甲状腺协会和美国临床内分泌医师协会的指南一致。对于亚临床甲状腺功能亢进，持续血清TSH<0.1 mIU/L应进行治疗，特别是如果病因是结节性毒性甲状腺肿。对于血清TSH在0.1 mIU/L与正常下限之间的情况，血清TSH合并症如心脏危险因素和骨质疏松症可能有利于进行治疗。
