Division of Endocrinology, Georgetown University, Washington, DC, USA.
Department of Endocrinology, University of Newcastle, Newcastle, UK.
Lancet Diabetes Endocrinol. 2019 Jun;7(6):473-483. doi: 10.1016/S2213-8587(18)30371-1. Epub 2019 Feb 21.
Although assigning a diagnosis of thyroid dysfunction appears quite simple, this is often not the case. Issues that make it unclear whether thyroid function is normal include transient changes in thyroid parameters, inter-individual and intra-individual differences in thyroid parameters, age-related differences, and ethnic variations. In addition, a statistically calculated distribution of thyroid analytes does not necessarily coincide with intervals or cutoffs that have predictive value for beneficial or adverse health outcomes. Based on current clincial trial data, it is unclear which individuals with mild thyroid-stimulating hormone elevations will benefit from levothyroxine treatment. For example, only a small number of patients with thyroid-stimulating hormone values of more than 10 mIU/L have been studied in a randomised manner. Even if therapy is initiated for abnormal thyroid function, not all treated individuals are maintained at the desired treatment target, and therefore might still be at risk. The consequence of this is that each patient's thyroid function needs to be assessed on an individual basis with the entire clinical picture in mind. Monitoring also needs to be vigilant, and the targets for treatment reassessed continually.
尽管诊断甲状腺功能障碍似乎相当简单，但情况并非总是如此。一些因素使得甲状腺功能是否正常变得不明确，包括甲状腺参数的短暂变化、个体间和个体内甲状腺参数的差异、与年龄相关的差异以及种族差异。此外，统计学上计算的甲状腺分析物的分布不一定与对健康有益或有害结果具有预测价值的区间或截止值相吻合。基于目前的临床试验数据，尚不清楚哪些轻度促甲状腺激素升高的个体将从左甲状腺素治疗中获益。例如，只有少数促甲状腺激素值超过 10 mIU/L 的患者被随机研究过。即使对异常甲状腺功能进行了治疗，并非所有接受治疗的个体都能维持在理想的治疗目标，因此仍然存在风险。其结果是，需要根据每位患者的个体情况并结合整个临床情况来评估甲状腺功能。监测也需要保持警惕，并不断重新评估治疗目标。
