Gabriel Botella F, Labios Gómez M, Galindo Puerto M J, Vicente Balaguer J, Arnal Babiloni M, Dualde Beltrán D
Servicio de Medicina Interna, Hospital Clínico Universitario, Valencia.
An Med Interna. 1995 Sep;12(9):425-30.
We have made a prospective study of 23 patients diagnosed of subclinical hypothyroidism and 45 of overt hypothyroidism, aged 68.3-70.3 years and with a mean illness of 4.5 and 6.5 years respectively. It has been proved a higher prevalence of females in both groups. The most frequent clinical symptoms, similar in both groups, were fatigue, constipation and dyspnea. The most repeated initial diagnosis at the entry were prymary hypothyroidism, heart failure, hypertensive urgencies and stroke. We have found differences of statistical significance between the Free Thyroxine (fT4), triiodothyronine (T3), total serum cholesterol (CT), triglycerides (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and thyrotropin (TSH) initial and ending serum levels in patients with overt hypothyroidism (p < 0.05). We only have found significant differences in TSH serum levels in patients with subclinical hypothyroidism. The antithyroglobulin and antimicrobial antibodies, have been both positive in two and one patient respectively. Both are more useful as a predictor than their diagnostic value. The levothyroxine (L-T4) daily dose needed to normalize the TSH serum concentration, was lesser in subclinical hypothyroidism (71.8 micrograms opposite 107 micrograms-p < 0.001). We didn't find significant differences between the different groups in the time necessary for normalizing TSH. It seems that the L-T4 therapy should be started in all patients with subclinical hypothyroidism and TSH > or = 10 microU/ml or with TSH > 5 and goiter or with thyroid antibodies. The aim to reach is to normalize the TSH serum levels. The mean daily necessary L-T4 dose is 50-100 micrograms.
我们对23例诊断为亚临床甲状腺功能减退症的患者和45例显性甲状腺功能减退症的患者进行了前瞻性研究，这些患者年龄在68.3至70.3岁之间，平均患病时间分别为4.5年和6.5年。已证实两组中女性的患病率更高。两组中最常见的临床症状相似，为疲劳、便秘和呼吸困难。入院时最常重复的初始诊断为原发性甲状腺功能减退症、心力衰竭、高血压急症和中风。我们发现显性甲状腺功能减退症患者的游离甲状腺素（fT4）、三碘甲状腺原氨酸（T3）、总血清胆固醇（CT）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）和促甲状腺激素（TSH）初始和最终血清水平之间存在统计学显著差异（p < 0.05）。我们仅在亚临床甲状腺功能减退症患者的TSH血清水平中发现了显著差异。抗甲状腺球蛋白抗体和抗微粒体抗体分别在2例和1例患者中呈阳性。两者作为预测指标比其诊断价值更有用。使TSH血清浓度正常化所需的左甲状腺素（L-T4）每日剂量，在亚临床甲状腺功能减退症中较低（71.8微克，而显性甲状腺功能减退症为107微克 - p < 0.001）。我们未发现不同组在使TSH正常化所需时间上存在显著差异。似乎所有亚临床甲状腺功能减退症且TSH≥10微单位/毫升或TSH>5且有甲状腺肿或有甲状腺抗体的患者均应开始L-T4治疗。目标是使TSH血清水平正常化。每日所需的平均L-T4剂量为50 - 100微克。
