亚临床甲状腺疾病

亚临床甲状腺疾病是指无或有轻微甲状腺疾病相关症状、仅在实验室检查中或通过影像学手段发现的甲状腺异常 ,包括甲状腺意外结节、亚临床甲状腺功能亢进、轻微甲状腺功能减退等。它们可影响正常的生理及代谢过程 ,部分患者可出现相关临床症状。亚临床甲状腺疾病应视患者的具体情况进行个体化处置     

亚临床甲状腺疾病

亚临床甲状腺疾病是指无或有轻微甲状腺疾病相关症状、仅在实验室检查中或通过影像学手段发现的甲状腺异常，包括甲状腺意外结节、亚临床甲状腺功能亢进、轻微甲状腺功能减退先进。它们可影响正常的生理及代谢过程，部分患者可出现相关临床症状。亚临床甲状腺疾病应视患者的具体情况进行个体化处置。     

增龄性亚临床甲状腺功能异常在抗衰老医学中的重要性

<正>神经和内分泌系统是人体两大中枢调控系统,二者相互协调,以维持人体内环境的平衡。甲状腺素分泌和释放受下丘脑-垂体-甲状腺轴调控,互为反馈,如亚临床甲状腺功能减退(及亢进)与促甲状腺释放激素(TSH)血清水平的升高(或降低)的关系。增龄性临床前甲状腺功能异常(又称亚临床甲状腺功能病STD)包括亚临床甲状腺功能减退(SHypo)、亚临床甲状腺功能亢进(SHyper)与一些疾病的相关关系必须给予重视。     

宁波市某石油化工企业退休老年人甲状腺功能异常患病率调查

目的 调查宁波市某石油化工企业全体老年退休员工甲状腺功能异常的患病情况.方法 采用普查方法 ,调查了该企业1709例60岁以上退休员工的甲状腺疾病史和甲状腺功能状况.结果在该老年人群中,已知甲状腺疾病的患病率为3.8%,女性6.7%,男性2.3%;否认有甲状腺疾病史者中,甲状腺功能异常的患病率为6.7%,女性9.7%,男性5.2%;该老年人群已知与新发现甲状腺功能异常的总患病率达10.2%.女性15.8%,男性7.4%.亚临床甲状腺功能减退症占新发现甲状腺功能异常者的87.3%. 结论 宁波市老年石化退休员工甲状腺功能异常患病率高达10.2%.以亚临床甲状腺功能减退最为多见,女性患病率高于男性.     

马鞍山地区糖尿病患者合并甲状腺疾病的调查

调查2009年10月至2011年6月于十七冶医院就诊的423例糖尿病患者的甲状腺功能,其中299例患者作了甲状腺超声检查。结果 (1)糖尿病患者合并甲状腺疾病的患病率为43.27%,其中甲状腺功能减退者占26.36%(临床甲减8.55%,亚临床甲减18.11%),甲状腺功能亢进者16.91%(临床甲亢10.61%,亚临床甲亢6.30%),低T3综合征者6.11%。(2)糖尿病患者中甲状腺疾病患病率女性高于男性,差异有统计学意义(P<0.05)。结论糖尿病与甲状腺疾病均是常见的内分泌代谢性疾病,二者并存并非少见,有时症状叠加互相影响,甲状腺疾病可加速糖尿病的进程,促进某些慢性并发症的发生;对于糖尿病合并甲状腺疾病患者应两病兼治。     

甲状腺疾病与脑血管病

在甲状腺功能亢进患者中,脑栓塞与甲状腺毒性心房颤动存在显著的相关性;在血清促甲状腺激素水平＜0.1 mU/L的亚临床甲状腺功能亢进患者中,毒性心房颤动的发生率亦显著增高.甲状腺功能亢进可能导致脑静脉血栓形成、烟雾病和巨细胞动脉炎;而甲状腺功能减退则与动脉粥样硬化的危险因素,尤其是高血压、高脂血症和高同型半胱氨酸血症有密切关系.但在亚临床甲状腺功能亢进患者中,这种联系尚不明确.     

亚临床甲状腺功能减退与认知障碍相关性的研究进展

亚临床甲状腺功能减退(亚甲减)和认知功能障碍都是老年人的常见的并存疾病。亚临床甲状腺功能减退常伴有尿酸、血脂等水平升高。亚临床甲状腺功能减退和认知功能障碍是否相关,血尿酸、血脂升高是否成为认知障碍的危险因素,仍然存在争议。本文旨在分析这些危险因素,从而探究亚甲减与认知障碍的相关性,探究高尿酸、高血脂水平对于认知障碍的作...     

甲状腺功能低下与亢进的脉冲多普勒诊断

目的：探讨脉冲多普勒对亚临床甲状腺功能低下和甲状腺功能亢进的鉴别诊断价值。方法：应用彩色多普勒和脉冲多普勒技术检查12例亚临床甲状腺功能低下和23例甲状腺功能亢进患者，测量双侧甲状腺上动脉的收缩期最大血流速度、舒张期末最低流速和阻力指数，用统计学方法进行分析。结果：甲状腺功能亢进患者的甲状腺上动脉各项血流动力学指标均高于亚临床甲状腺功能低下者，经t检验，2种疾病各项指标间差异均有显著意义（P＜0．01）。左、右侧甲状腺上动脉收缩期最大血流速度t值分别为3．220，2859；舒张期末最低流速t值为2．806，2．941；阻力指数为4．1923，3．273。 应用脉冲多普勒技术诊断亚临界甲状腺功能低下的准确率为83．33％；诊断甲状腺功能亢进的准确率为91．30％。结论：脉冲多普勒不便能诊断亚临界甲状腺功能低下和甲状腺功能亢进，而且是鉴别此2种疾病的可靠方法。     

妊娠与甲状腺疾病

妊娠甲状腺疾病可分为妊娠前原有甲状腺疾病和妊娠中伴发甲状腺疾病，甲状腺疾病是妊娠妇女最常见的疾病之一，其发病率1％～2％[不包括大量的没有被发现的亚临床甲状腺功能减退症（甲减）与甲状腺功能亢进症（甲亢）]。现日益清楚，有临床症状和临床症状不明显的甲状腺疾病都会影响生育，对母亲和胎儿产生长期和短期的不良影响。因此妊娠甲状腺疾病值得重视。     

妊娠甲状腺功能减退症研究的近期进展

妊娠甲状腺功能减退症(甲减)是近期内分泌学界关注的一个热点领域.本文重点介绍了美国内分泌学会2007年颁布的<妊娠和产后甲状腺功能异常处理的临床指南>提出的六点共识意见;妊娠时诊断甲状腺功能异常应当依据妊娠不同时期特异的甲状腺功能参考值,否则亚临床甲减可能被漏诊;妊娠相关的亚临床甲状腺异常有三种情况,即亚临床甲减、单纯低T4血症和单纯甲状腺过氧化物酶抗体(TPOAb)阳性,指南对这些异常的诊断提出了见解.     

Pericardial effusion associated with subclinical hypothyroidism

Previous studies have suggested that subclinical thyroid dysfunction, as manifested by abnormalities in thyroid-stimulating hormone (TSH) levels, are associated with detrimental effects on the cardiovascular system. Subclinical hyperthyroidism is an increasingly recognized entity that is defined as a normal serum free thyroxine and free triiodothyronine levels with a thyroid-stimulating hormone level suppressed below the normal range and usually undetectable. It has been reported that subclinical hyperthyroidism is not associated with coronary heart disease or mortality from cardiovascular causes but it is sufficient to induce arrhythmias including atrial fibrillation and atrial flutter. It has also been reported that increased factor X activity in patients with subclinical hyperthyroidism represents a potential hypercoagulable state. Subclinical hypothyroidism is defined by elevated serum levels of TSH with normal levels of free thyroid hormones. Subclinical hypothyroidism is characterized by abnormal lipid metabolism, cardiac dysfunction, diastolic hypertension conferring an elevated risk of atherosclerosis, and ischemic heart disease. It has been reported that sub-clinical hypothyroidism is associated with both, a significant risk of coronary heart disease at baseline and at follow-up and that mortality from cardiovascular causes is significantly higher at follow-up. However subclinical thyroid dysfunction is currently the subject of numerous studies and remains controversial, particularly as it relates to cardiovascular morbidity and mortality and clinical applications. Pericardial effusion can be present in systemic disorders including hypothyroidism. We present a case of subclinical hypothyroidism in a 41-year-old Italian woman with an ubiquitary pericardial effusion. Also this case focuses attention on subclinical hypothyroidism.     

Prevalence of subclinical thyroid dysfunction and its relation to socioeconomic deprivation in the elderly: a community-based cross-sectional survey

CONTEXT: Population-based screening has been advocated for subclinical thyroid dysfunction in the elderly because the disorder is perceived to be common, and health benefits may be accrued by detection and treatment. OBJECTIVE: The objective of the study was to determine the prevalence of subclinical thyroid dysfunction and unidentified overt thyroid dysfunction in an elderly population. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey of a community sample of participants aged 65 yr and older registered with 20 family practices in the United Kingdom. EXCLUSIONS: Exclusions included current therapy for thyroid disease, thyroid surgery, or treatment within 12 months. OUTCOME MEASURE: Tests of thyroid function (TSH concentration and free T4 concentration in all, with measurement of free T3 in those with low TSH) were conducted. EXPLANATORY VARIABLES: These included all current medical diagnoses and drug therapies, age, gender, and socioeconomic deprivation (Index of Multiple Deprivation, 2004). ANALYSIS: Standardized prevalence rates were analyzed. Logistic regression modeling was used to determine factors associated with the presence of subclinical thyroid dysfunction. RESULTS: A total of 5960 attended for screening. Using biochemical definitions, 94.2% [95% confidence interval (CI) 93.8-94.6%] were euthyroid. Unidentified overt hyper- and hypothyroidism were uncommon (0.3, 0.4%, respectively). Subclinical hyperthyroidism and hypothyroidism were identified with similar frequency (2.1%, 95% CI 1.8-2.3%; 2.9%, 95% CI 2.6-3.1%, respectively). Subclinical thyroid dysfunction was more common in females (P < 0.001) and with increasing age (P < 0.001). After allowing for comorbidities, concurrent drug therapies, age, and gender, an association between subclinical hyperthyroidism and a composite measure of socioeconomic deprivation remained. CONCLUSIONS: Undiagnosed overt thyroid dysfunction is uncommon. The prevalence of subclinical thyroid dysfunction is 5%. We have, for the first time, identified an independent association between the prevalence of subclinical thyroid dysfunction and deprivation that cannot be explained solely by the greater burden of chronic disease and/or consequent drug therapies in the deprived population.     

Thyroid Function Abnormalities and Cognitive Impairment in Elderly People: Results of the Invecchiare in Chianti Study

OBJECTIVES: To investigate thyroid function testing abnormalities in older persons and to explore the relationship between thyroid dysfunction and cognition.
DESIGN: Cross-sectional.
SETTING: Community-based.
PARTICIPANTS: One thousand one hundred seventy-one men and women aged 23 to 102.
MEASUREMENTS: Thyroid function was evaluated by measuring plasma concentrations of thyrotropin (TSH), free thyroxine (FT4), and free triiodothyronine (FT3). Cognition was evaluated using the Mini-Mental State Examination (MMSE). Prevalence of overt and subclinical thyroid dysfunction was evaluated in different age groups (<65 vs ≥65). Age trends in TSH, FT4, and FT3 were examined in euthyroid participants. The cross-sectional association between thyroid dysfunction and MMSE score was evaluated adjusting for confounders.
RESULTS: Subclinical hypothyroidism and subclinical hyperthyroidism were more prevalent in older than in younger participants (subclinical hypothyroidism, 3.5% vs 0.4%, P <.03; subclinical hyperthyroidism, 7.8% vs 1.9%, P <.002). In euthyroid participants, TSH and FT3 declined with age, whereas FT4 increased. Older participants with subclinical hyperthyroidism had lower MMSE scores than euthyroid subjects (22.61±6.88 vs 24.72±4.52, P <.03). In adjusted analyses, participants with subclinical hyperthyroidism were significantly more likely to have cognitive dysfunction (hazard rate=2.26, P =.003).
CONCLUSION: Subtle age-related changes in FT3, FT4, and TSH occur in individuals who remain euthyroid. Subclinical hyperthyroidism is the most prevalent thyroid dysfunction in Italian older persons and is associated with cognitive impairment.     

亚临床甲状腺功能异常与心血管疾病的关系

临床研究显示,亚临床甲状腺功能异常与心血管疾病之间存在密切的关系.亚临床甲状腺功能减退通常伴有血脂异常、高凝状态、纤维蛋白溶解活性减低等心血管疾病危险因素,其与动脉粥样硬化、冠心病和心血管死亡的风险显著相关.另一方面,亚临床甲状腺功能亢进与心房颤动发生风险显著相关,但与心血管死亡风险的相关性尚不清楚.对于亚临床甲状腺功能异常进行治疗是否能够带来心血管获益,目前尚无确切结论.     

亚临床甲状腺功能异常与心血管疾病的关系

临床研究显示,亚临床甲状腺功能异常与心血管疾病之间存在密切的关系.亚临床甲状腺功能减退通常伴有血脂异常、高凝状态、纤维蛋白溶解活性减低等心血管疾病危险因素,其与动脉粥样硬化、冠心病和心血管死亡的风险显著相关.另一方面,亚临床甲状腺功能亢进与心房颤动发生风险显著相关,但与心血管死亡风险的相关性尚不清楚.对于亚临床甲状腺功能异常进行治疗是否能够带来心血管获益,目前尚无确切结论.     

亚临床甲状腺功能异常与心血管疾病的关系

临床研究显示,亚临床甲状腺功能异常与心血管疾病之间存在密切的关系.亚临床甲状腺功能减退通常伴有血脂异常、高凝状态、纤维蛋白溶解活性减低等心血管疾病危险因素,其与动脉粥样硬化、冠心病和心血管死亡的风险显著相关.另一方面,亚临床甲状腺功能亢进与心房颤动发生风险显著相关,但与心血管死亡风险的相关性尚不清楚.对于亚临床甲状腺功能异常进行治疗是否能够带来心血管获益,目前尚无确切结论.     

Cardiovascular risk with subclinical hyperthyroidism and hypothyroidism: pathophysiology and management

Previous studies have suggested that subclinical thyroid dysfunction, as manifested by abnormalities in thyroid-stimulating hormone (TSH) levels, are associated with detrimental effects on the cardiovascular system. Subclinical hypothyroidism is characterized by abnormal lipid metabolism, cardiac dysfunction, diastolic hypertension conferring an elevated risk of atherosclerosis, and ischemic heart disease. Similarly, patients with subclinical hyperthyroidism have nearly 3 times the likelihood of atrial fibrillation over a 10-year follow-up interval, raising the question of whether patients with subclinical hyperthyroidism should be treated to prevent atrial fibrillation. A single measurement of low serum TSH in individuals aged 60 years or older has been reported to be associated with increased mortality from all causes and in particular from circulatory and cardiovascular disease in a 10-year follow-up study. Subclinical thyroid dysfunction is currently the subject of numerous studies and remains controversial, particularly as it relates to cardiovascular morbidity and mortality and clinical applications.     

Subclinical hypothyroidism,lipid metabolism and cardiovascular disease

Subclinical hypothyroidism is defined by elevated serum thyrotropin in presence of normal free thyroid hormones. Lipid metabolism is influenced by thyroid hormone and many reports showed that lipids status worsen along with TSH level. Subclinical hypothyroidism has been also linked to other cardiovascular risk factors such as alteration in blood pressure and increased atherosclerosis. Further evidences suggested that mild dysfunction of thyroid gland is associated with metabolic syndrome and heart failure. Thyrotropin level seems the best predictor of cardiovascular disease, in particular when its levels are above 10 mU/L. However, despite these observations, there is no clear evidence that levothyroxine therapy in subjects with milder form of subclinical hypothyroidism could improve lipid status and the other cardiovascular risk factors. In this review, we address the effect of thyroid hormone and cardiovascular risk, with a focus on lipid metabolism.     

Subclinical thyroid disease

Subclinical thyroid diseases--subclinical hyperthyroidism and subclinical hypothyroidism--are common clinical entities that encompass mild degrees of thyroid dysfunction. The clinical significance of mild thyroid overactivity and underactivity is uncertain, which has led to controversy over the appropriateness of diagnostic testing and possible treatment. In this Seminar, we discuss the definition, epidemiology, differential diagnoses, risks of progression to overt thyroid disease, potential effects on various health outcomes, and management of subclinical hyperthyroidism and subclinical hypothyroidism. Treatment recommendations are based on the degree to which thyroid-stimulating hormone concentrations have deviated from normal and underlying comorbidities. Large-scale randomised trials are urgently needed to inform how to best care for individuals with subclinical thyroid disease.     

Subclinical thyroid dysfunction in the elderly.

Subclinical thyroid dysfunction is more common in older persons. By definition, these disorders are recognized by isolated elevation or suppression of the serum TSH concentration, in association with a normal serum free thyroxine level. Among individuals over 65 years old, subclinical hypothyroidism is found in approximately 10% of women and approximately 3% of men. It is most commonly due to autoimmune thyroiditis or previous treatment for hyperthyroidism. There may be three indications for L-thyroxine therapy: (a) presence of antithyroid antibodies, indicating substantial risk of progression to over hypothyroidism; (b) symptoms consistent with thyroid hormone deficiency; and (c) an elevated serum LDL-cholesterol. Subclinical hyperthyroidism is present in approximately 1%-2% of older persons. The most common cause is excessive thyroid hormone therapy, followed by mild endogenous hyperthyroidism due to Graves' disease or nodular goiter. These can be differentiated from other causes of low serum TSH concentration based on clinical and other laboratory and radionuclide scan criteria. The most serious consequences of subclinical hyperthyroidism are atrial fibrillation and osteoporosis, to which elderly patients are particularly predisposed.