Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China.
Front Endocrinol (Lausanne). 2022 Jul 14;13:913749. doi: 10.3389/fendo.2022.913749. eCollection 2022.
Subclinical hypothyroidism (SCH) is usually treated with levothyroxine, but there is controversy as to whether SCH should be treated, especially for older patients. The aim of the systematic review and meta-analysis was to evaluate whether levothyroxine has a beneficial or harmful effect on older patients with SCH.
Databases including PubMed, Embase, Cochrane Library, Web of Science, Wanfang, Weipu and China National Knowledge Infrastructure were searched from inception until December 21, 2021. Subjects must be diagnosed with SCH, and older than or equal to 60 years of age. Interventions should be thyroid hormone therapy (e.g. levothyroxine). The literature was independently screened by 2 researchers. Statistical analysis was performed using RevMan5.3 software.
A total of 13 articles were included. Meta-analysis results showed that in older SCH patients, levothyroxine can significantly reduce cholesterol (TC) ( < 0.00001), triglyceride (TG) ( < 0.00001), low-density lipoprotein cholesterol (LDL-C) ( = 0.03) and apolipoprotein B (ApoB) ( < 0.00001). In addition, levothyroxine had no significant effect on bone mineral density, fatigue, hypothyroidism symptoms, quality of life, BMI, cognitive function, depression, blood pressure, etc. in older SCH patients, and also did not significantly increase the incidence of adverse events.
Among older SCH patients, levothyroxine treatment may reduce TC, TG, LDL-C, and ApoB.
亚临床甲状腺功能减退症（SCH）通常用左甲状腺素治疗，但对于 SCH 患者是否应进行治疗，尤其是老年患者，存在争议。本系统评价和荟萃分析的目的是评估左甲状腺素对 SCH 老年患者是否有益或有害。
从建库起至 2021 年 12 月 21 日，检索 PubMed、Embase、 Cochrane Library、Web of Science、万方、维普和中国知网数据库。纳入的研究对象必须被诊断为 SCH，且年龄≥60 岁。干预措施应为甲状腺激素治疗（如左甲状腺素）。由 2 位研究人员独立筛选文献。采用 RevMan5.3 软件进行统计学分析。
共纳入 13 项研究。荟萃分析结果显示，在 SCH 老年患者中，左甲状腺素治疗可显著降低胆固醇（TC）（<0.00001）、甘油三酯（TG）（<0.00001）、低密度脂蛋白胆固醇（LDL-C）（=0.03）和载脂蛋白 B（ApoB）（<0.00001）。此外，左甲状腺素对 SCH 老年患者的骨密度、疲劳、甲状腺功能减退症状、生活质量、BMI、认知功能、抑郁、血压等无显著影响，也不会显著增加不良反应的发生率。
在 SCH 老年患者中，左甲状腺素治疗可能会降低 TC、TG、LDL-C 和 ApoB。
