Kennedy J W, Caro J F
Joslin Diabetes Center, Harvard University, Boston, USA.
Geriatrics. 1996 May;51(5):22-4,27,31-2.
Hyperthyroidism in the older patient often presents with nonspecific symptoms, such as apathy, weight loss, and atrial fibrillation. General screening is not cost-effective, with the exception of two populations: women over age 40 with one or more nonspecific complaints and patients being admitted to a specialized geriatric unit. The sensitive TSH test is an excellent screen; a low TSH should be confirmed by an actual or estimated high free thyroxine test (FT4). The RAIU can help narrow the differential diagnosis. Radioiodine is the preferred treatment for the older patient with Graves' disease, the most common form of thyrotoxicosis. Graves' must be differentiated from thyroiditis and toxic nodular goiters, as treatment regimens differ for each disorder.
老年患者的甲状腺功能亢进症常表现为非特异性症状，如淡漠、体重减轻和心房颤动。除两类人群外，一般筛查并不具有成本效益：有一项或多项非特异性主诉的40岁以上女性，以及入住专门老年病房的患者。敏感的促甲状腺激素（TSH）检测是一种很好的筛查方法；低TSH应通过实际或估算的高游离甲状腺素（FT4）检测来确认。放射性碘摄取（RAIU）有助于缩小鉴别诊断范围。放射性碘是患有格雷夫斯病（Graves' disease）的老年患者的首选治疗方法，格雷夫斯病是甲状腺毒症最常见的形式。必须将格雷夫斯病与甲状腺炎和毒性结节性甲状腺肿区分开来，因为每种疾病的治疗方案不同。
