Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California; Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California.
Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California; Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California.
Endocr Pract. 2021 Mar;27(3):254-260. doi: 10.1016/j.eprac.2021.02.002. Epub 2021 Feb 13.
Subclinical hyperthyroidism (SCHyper) is a biochemical diagnosis characterized by a decreased serum thyroid-stimulating hormone (TSH) and normal serum thyroxine (T4) and triiodothyronine (T3) concentrations. Because SCHyper can be resolved, it is recommended to repeat serum TSH, T3, and T4 concentrations in 3 to 6 months before confirming a diagnosis of SCHyper to consider treatment. Proposed grading systems distinguish between mild (TSH, 0.1-0.4 mIU/L) and severe SCHyper (TSH, <0.1 mIU/L) and are used alongside patients' age and the presence of risk factors and symptoms to guide treatment. Appropriate evaluation includes an investigation of the underlying cause and assessment of an individual's risk factors to determine the necessity and type of treatment that may be recommended. SCHyper may be associated with increased risks of cardiovascular-related adverse outcomes, bone loss, and in some studies, cognitive decline. Treatment may include observation without therapy, initiation of antithyroid medications, or pursuit of radioiodine therapy or thyroid surgery. Considerations for treatment include the SCHyper etiology, anticipated long-term natural history of the condition, potential benefits of correcting the thyroid dysfunction, and risks and benefits of each treatment option. The purpose of this overview is to provide a guide for clinicians in evaluating and managing SCHyper in the routine clinical practice.
亚临床甲状腺功能亢进症（SCHyper）是一种生化诊断，其特征是血清促甲状腺激素（TSH）降低，血清甲状腺素（T4）和三碘甲状腺原氨酸（T3）浓度正常。由于 SCHyper 可以自行缓解，因此建议在确诊 SCHyper 之前，在 3 至 6 个月内重复检测血清 TSH、T3 和 T4 浓度，以考虑治疗。提出的分级系统区分了轻度（TSH，0.1-0.4mIU/L）和重度 SCHyper（TSH，<0.1mIU/L），并结合患者的年龄、危险因素和症状来指导治疗。适当的评估包括对潜在病因的调查以及对个体危险因素的评估，以确定可能推荐的治疗的必要性和类型。SCHyper 可能与心血管相关不良结局、骨丢失的风险增加有关，在某些研究中还与认知能力下降有关。治疗可能包括观察而不进行治疗、开始抗甲状腺药物治疗、或选择放射性碘治疗或甲状腺手术。治疗的考虑因素包括 SCHyper 的病因、预期的疾病长期自然史、纠正甲状腺功能障碍的潜在益处，以及每种治疗选择的风险和益处。本综述的目的是为临床医生在常规临床实践中评估和管理 SCHyper 提供指导。
