Investigating hypothyroidism.
Investigating hypothyroidism.
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研究甲状腺功能减退症。
DOI：
10.1136/bmj.n993
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Pearce,ElizabethN
中科院分区：
文献类型：
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作者：
Siskind,SamanthaM;Lee,SunY;Pearce,ElizabethN
背景甲状腺功能减退症很难诊断，因为它的体征和症状是非特异性的，并且在筛查方面没有全球共识。很难确定何时测试甲状腺功能减退症，因为患者可能会出现轻微或与其他常见疾病重叠的症状，并且关于谁和何时测试的指南可能是模糊的。然而，识别明显的甲状腺功能减退症是重要的，因为如果不治疗，它可能会导致不舒服的症状，以及心脏功能障碍，高血压，血脂异常，认知障碍，妊娠并发症的风险增加，在罕见的情况下，粘液水肿昏迷。[1]虽然专业组织通常建议不要进行甲状腺功能减退症的普遍筛查，但存在差异，指南对谁进行测试仍然模糊，通常建议考虑在临床高度怀疑疾病的患者或风险增加的人群中进行测试，尽管他们并不总是定义这些人群。该指南的广泛性反映了这种疾病可能出现的广泛方式以及可能发展的人（表1）。在碘充足的国家，显性甲状腺功能减退症的患病率从1%到2%不等，在老年人中上升到7%。5甲状腺功能减退症在女性中的发生率大约是男性的10倍。5
BackgroundHypothyroidism can be difficult to diagnose, as its signs and symptoms are non-specific, and no global consensus exists on screening. It can be difficult to determine when to test for hypothyroidism, as patients may present with symptoms that are subtle or that overlap with other common conditions, and guidelines can be vague regarding who and when to test. However, identification of overt hypothyroidism is important as, if left untreated, it can cause uncomfortable symptoms as well as increased risk for cardiac dysfunction, hypertension, dyslipidaemia, cognitive impairment, complications in pregnancy, and in rare cases, myxoedema coma. 1 While professional organisations generally recommend against universal screening for hypothyroidism, discrepancy exists and guidelines remain vague about who to test, generally recommending consideration of testing in patients for whom there is high clinical suspicion of the disease or in populations at increased risk, although they do not always define these populations. The broad nature of the guidelines reflects the wide range of ways this disease may present and who is likely to develop it (table 1). In countries that are iodine sufficient, the prevalence of overt hypothyroidism ranges from 1% to 2%, rising to 7% in older adults. 5 Hypothyroidism is approximately 10 times more common in women than in men. 5