OCCULT THYROID DISEASE IN AN ELDERLY HOSPITALIZED POPULATION
OCCULT THYROID DISEASE IN AN ELDERLY HOSPITALIZED POPULATION
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DOI：
10.1093/geronj/33.3.372
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发表时间：
1978-01-01
期刊：
影响因子：
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通讯作者：
NICHOLS, AL
中科院分区：
文献类型：
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作者：
ATKINSON, RL;DAHMS, WT;NICHOLS, AL
对 425 名 60 岁以上住院患者进行了甲状腺素 (T4)、三碘甲状腺原氨酸 (T3)、促甲状腺素 (TSH) 和 T3 滑石粉摄取 (T3TU) 的测量。 10 名患者（2.4%）发现未怀疑的甲状腺疾病； 9 例甲状腺功能减退症，1 例甲状腺功能亢进症。另外 11% 的人群 T4 或 TSH 水平异常，但没有患有甲状腺疾病。对 40 名血清 T4 浓度较低的患者中的 10 名进行重复测量，结果显示测试结果恢复正常。低 T4 水平发生在病情严重的患者中，通常与低 T3TU 值相关。其中 32 名患者的血清 T3 浓度较低。虽然 TSH 是诊断甲状腺功能减退症最有用的测试，但它是一项相对昂贵的测试，并且对筛查甲状腺功能亢进没有帮助。筛查隐匿性甲状腺疾病的最佳单一测试是血清 T4 测量，建议所有 60 岁以上住院患者进行。如果 T4 结果低于 6.5 μg/dl，则应将血清保存在实验室中以测量 TSH 浓度。如果血清 T4 浓度升高，应进行 T3 树脂或滑石粉摄取以及血清 T3 测量，以排除甲状腺功能亢进。该方案几乎可以识别所有隐匿性甲状腺疾病病例。
Measurements of thyroxine (T4), triiodothyronine (T3), thyrotropin (TSH), and T3 talc uptake (T3TU) were performed on 425 hospitalized patients over 60 yr of age. Unsuspected thyroid disease was found in 10 patients (2.4%); 9 were hypothyroid and 1 hyperthyroid. Another 11% of the population had abnormal T4 or TSH levels but did not have thyroid disease. Repeat measurements in 10 of 40 patients with low serum T4 concentrations showed a return of the tests to normal. The low T4 levels occurred in patients who were seriously ill and were usually associated with low T3TU values. Low serum T3 concentrations were observed in 32 of the patients. Although TSH was the most useful test in the diagnosis of hypothyroidism, it is a relatively expensive test and is not helpful in screening for hyperthyroidism. The best single test for screening for occult thyroid disease is a serum T4 measurement and is recommended for all hospitalized patients over age 60 yr. Serum should be held in the laboratory for measurement of TSH concentration if the T4 result is below 6.5 .mu.g/dl. A T3 resin or talc uptake and a serum T3 measurement should be performed to rule out hyperthyroidism if the serum T4 concentration is elevated. This regimen will identify virtually all cases of occult thyroid disease.