Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
Medicina (Kaunas). 2020 Jan 19;56(1):40. doi: 10.3390/medicina56010040.
levothyroxine prescriptions have increased remarkably during the last decade, and it is most likely to be prescribed in subclinical hypothyroidism. The aim of this review was to present data on when levothyroxine treatment should be initiated, and the effects of treatment in subclinical hypothyroidism on symptoms such as weight, quality of life, vitality, cognition, and cardiovascular disease. We also discuss evidence for different thyroid-hormone medications. In addition, the option to withhold medication when there is uncertain diagnosis or lack of clinical improvement is discussed.
a literature search in PubMed on the term "treatment of subclinical hypothyroidism" in combination with "quality of life", "weight", "cognition", and "cerebrovascular disease".
current research supports that levothyroxine should be initiated in patients with a thyroid stimulating hormone (TSH) >10 mIU/L. Treatment for hypothyroidism is becoming more frequent. Symptoms related to vitality, weight, and quality of life in subclinical disease often persist with levothyroxine treatment, and other causes should be explored. Patients with cardiovascular-risk factors may benefit from treatment, especially younger patients. Caution is necessary when treating elderly subjects with levothyroxine.
lifelong treatment with levothyroxine should normally only be considered in manifest hypothyroidism. However, in subclinical hypothyroidism with a TSH >10 mIU/L, therapy is indicated. In milder subclinical forms, a wait-and-see strategy is advocated to see if normalization occurs. Subgroups with cardiovascular risk and subclinical hypothyroidism may benefit from levothyroxine therapy.
在过去十年中，左甲状腺素的处方量显著增加，而且很可能在亚临床甲状腺功能减退症中开具。本综述的目的是提供关于何时应开始左甲状腺素治疗的数据，以及亚临床甲状腺功能减退症中治疗对体重、生活质量、活力、认知和心血管疾病等症状的影响。我们还讨论了不同甲状腺激素药物的证据。此外，还讨论了在诊断不确定或缺乏临床改善时选择停药的问题。
在 PubMed 上搜索术语“亚临床甲状腺功能减退症的治疗”，并结合“生活质量”、“体重”、“认知”和“脑血管疾病”进行搜索。
目前的研究支持对 TSH>10mIU/L 的患者应开始左甲状腺素治疗。甲状腺功能减退症的治疗越来越频繁。亚临床疾病中与活力、体重和生活质量相关的症状常常在用左甲状腺素治疗后持续存在，应探索其他原因。有心血管危险因素的患者可能受益于治疗，尤其是年轻患者。在治疗老年患者时应谨慎。
在明显的甲状腺功能减退症中，通常仅应考虑终身用左甲状腺素治疗。然而，在 TSH>10mIU/L 的亚临床甲状腺功能减退症中，应进行治疗。在更轻微的亚临床形式中，提倡采取观望策略，观察是否会出现正常化。有心血管风险和亚临床甲状腺功能减退症的亚组可能受益于左甲状腺素治疗。
