Hypothyroidism
Hypothyroidism
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DOI：
10.1038/s41572-022-00357-7
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发表时间：
2022-05-19
影响因子：
81.5
通讯作者：
Peeters, Robin P.
中科院分区：
文献类型：
--
作者：
Chaker, Loyal;RazvID, Salmon;Peeters, Robin P.
甲状腺功能减退症是一种常见的甲状腺激素分泌或代谢不足的情况，如果不治疗可能危及生命。本文综述了甲状腺功能减退症的流行病学、发病机制、诊断、筛查和预防方案、目前的治疗方法以及需要进一步研究的领域。甲状腺功能减退症是甲状腺激素缺乏症的常见临床症状，如果不及时治疗，可导致多器官系统的严重不良健康影响，其中心血管系统是研究最多的目标。显性原发性甲状腺功能减退被定义为促甲状腺激素（TSH）浓度升高并游离甲状腺素（fT(4)）浓度低于参考范围。亚临床甲状腺功能减退，通常被认为是甲状腺功能衰竭的早期征兆，定义为TSH浓度升高，但fT(4)浓度在参考范围内。甲状腺功能减退症根据甲状腺、垂体或下丘脑或外周组织的病理分别分为原发性、中枢性或外周性。获得性原发性甲状腺功能减退是最常见的形式，可由严重的碘缺乏引起，但在碘丰富的地区，更常见的是由慢性自身免疫性甲状腺炎引起的。在大多数情况下，甲状腺功能减退的发作是隐匿的，症状可能在疾病过程中相对较晚出现。临床表现和甲状腺功能减退症状存在很大差异，特别是在怀孕和儿童中。左旋甲状腺素（LT4）是治疗的主要手段，也是世界上最常用的处方药之一。在TSH和fT(4)浓度正常化后，相当一部分接受LT4治疗的患者仍有持续的抱怨，影响了生活质量。目前应用的参考范围和治疗阈值的适宜性，特别是在妊娠期，以及LT4/碘甲状腺原氨酸联合治疗在甲状腺相关症状缓解、患者满意度和长期不良反应方面的潜在益处，需要进一步研究。
Hypothyroidism is a common condition of insufficient thyroid hormone production or metabolism, which can be life-threatening if untreated. This Primer reviews hypothyroidism epidemiology, pathogenesis, diagnosis, screening and prevention programmes, current treatment approaches, and areas for additional research.Hypothyroidism is the common clinical condition of thyroid hormone deficiency and, if left untreated, can lead to serious adverse health effects on multiple organ systems, with the cardiovascular system as the most robustly studied target. Overt primary hypothyroidism is defined as elevated thyroid-stimulating hormone (TSH) concentration in combination with free thyroxine (fT(4)) concentration below the reference range. Subclinical hypothyroidism, commonly considered an early sign of thyroid failure, is defined by elevated TSH concentrations but fT(4) concentrations within the reference range. Hypothyroidism is classified as primary, central or peripheral based on pathology in the thyroid, the pituitary or hypothalamus, or peripheral tissue, respectively. Acquired primary hypothyroidism is the most prevalent form and can be caused by severe iodine deficiency but is more frequently caused by chronic autoimmune thyroiditis in iodine-replete areas. The onset of hypothyroidism is insidious in most cases and symptoms may present relatively late in the disease process. There is a large variation in clinical presentation and the presence of hypothyroid symptoms, especially in pregnancy and in children. Levothyroxine (LT4) is the mainstay of treatment and is one of the most commonly prescribed drugs worldwide. After normalization of TSH and fT(4) concentrations, a considerable proportion of patients treated with LT4 continue to have persistent complaints, compromising quality of life. Further research is needed regarding the appropriateness of currently applied reference ranges and treatment thresholds, particularly in pregnancy, and the potential benefit of LT4/liothyronine combination therapy for thyroid-related symptom relief, patient satisfaction and long-term adverse effects.