向老年人群中低价值甲状腺护理的去执行化迈进。
Towards De-Implementation of low-value thyroid care in older adults.
机构信息
Division of Endocrinology, Departments of Medicine and Surgery, University of California San Francisco, San Francisco, CA.
Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
出版信息
Curr Opin Endocrinol Diabetes Obes. 2022 Oct 1;29(5):483-491. doi: 10.1097/MED.0000000000000758. Epub 2022 Jul 22.
PURPOSE OF REVIEW
This review discusses the current literature regarding low-value thyroid care in older adults, summarizing recent findings pertaining to screening for thyroid dysfunction and management of hypothyroidism, thyroid nodules and low-risk differentiated thyroid cancer.
RECENT FINDINGS
Despite a shift to a "less is more" paradigm for clinical thyroid care in older adults in recent years, current studies demonstrate that low-value care practices are still prevalent. Ineffective and potentially harmful services, such as routine treatment of subclinical hypothyroidism which can lead to overtreatment with thyroid hormone, inappropriate use of thyroid ultrasound, blanket fine needle aspiration biopsies of thyroid nodules, and more aggressive approaches to low-risk differentiated thyroid cancers, have been shown to contribute to adverse effects, particularly in comorbid older adults.
SUMMARY
Low-value thyroid care is common in older adults and can trigger a cascade of overdiagnosis and overtreatment leading to patient harm and increased healthcare costs, highlighting the urgent need for de-implementation efforts.
目的综述
本篇综述讨论了当前有关老年人低价值甲状腺治疗的文献，总结了最近关于甲状腺功能障碍筛查以及甲状腺功能减退症、甲状腺结节和低危分化型甲状腺癌的管理方面的发现。
最近的发现
尽管近年来老年人临床甲状腺治疗的“少即是多”理念有所转变，但目前的研究表明，低价值的治疗方法仍然很普遍。无效和潜在有害的服务，如亚临床甲状腺功能减退症的常规治疗，可能导致甲状腺激素过度治疗，不适当使用甲状腺超声，甲状腺结节的常规细针抽吸活检，以及对低危分化型甲状腺癌更积极的治疗方法，已被证明会导致不良后果，特别是在合并症较多的老年患者中。
总结
低价值的甲状腺治疗在老年人中很常见，会引发一系列过度诊断和过度治疗，导致患者受到伤害并增加医疗保健费用，这突显了迫切需要实施去干预措施。
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