The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism
The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism
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DOI：
10.1159/000438750
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发表时间：
2015-01-01
影响因子：
4.7
通讯作者：
Kahaly, George J.
中科院分区：
文献类型：
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作者：
Biondi, Bernadette;Bartalena, Luigi;Kahaly, George J.
内源性亚临床甲状腺功能亢进（SHyper）是由Graves病、自主功能甲状腺结节和多结节性甲状腺肿引起的。其诊断是基于持续低于正常的血清促甲状腺激素（TSH）水平和在各自参考区间内的游离甲状腺激素水平。2014年，欧洲甲状腺协会执行委员会（European Thyroid Association Executive Committee）考虑到有关Endo SHyper治疗的争议，成立了一个工作组，根据循证医学原则制定临床实践指南。工作组认识到，最近的荟萃分析，包括那些基于大型前瞻性队列研究的荟萃分析表明，SHyper与血清TSH水平< 0.1 mIU/l的患者冠心病死亡率、房颤发生率、心力衰竭、骨折和额外死亡率增加相关（2级SHyper）。因此，尽管缺乏随机前瞻性试验，但有证据表明，65岁以上的2级SHyper患者需要治疗，以潜在地避免这些严重的心血管事件、骨折和进展为明显甲状腺功能亢进的风险。对于年龄大于65岁且TSH水平为0.1-0.39 mIU/l（1级SHyper）的患者可以考虑治疗，因为他们的房颤风险增加，对于年龄较小（< 65岁）的有症状的2级SHyper患者也可能是合理的，因为有进展的风险，特别是在存在症状和/或潜在危险因素或合并症的情况下。最后，工作组得出结论，没有数据支持在年轻无症状的1级SHyper患者中治疗SHyper。由于进展为明显甲状腺功能亢进的风险较低，且不良健康结果的证据较弱，这些患者应在不进行治疗的情况下随访。
Endogenous subclinical hyperthyroidism (SHyper) is caused by Graves' disease, autonomously functioning thyroid nodules and multinodular goitre. Its diagnosis is based on a persistently subnormal serum thyroid-stimulating hormone (TSH) level with free thyroid hormone levels within their respective reference intervals. In 2014 the European Thyroid Association Executive Committee, given the controversies regarding the treatment of Endo SHyper, formed a task force to develop clinical practice guidelines based on the principles of evidence-based medicine. The task force recognized that recent meta-analyses, including those based on large prospective cohort studies, indicate that SHyper is associated with increased risk of coronary heart disease mortality, incident atrial fibrillation, heart failure, fractures and excess mortality in patients with serum TSH levels < 0.1 mIU/l (grade 2 SHyper). Therefore, despite the absence of randomized prospective trials, there is evidence that treatment is indicated in patients older than 65 years with grade 2 SHyper to potentially avoid these serious cardiovascular events, fractures and the risk of progression to overt hyperthyroidism. Treatment could be considered in patients older than 65 years with TSH levels 0.1-0.39 mIU/l (grade 1 SHyper) because of their increased risk of atrial fibrillation, and might also be reasonable in younger (< 65 years) symptomatic patients with grade 2 SHyper because of the risk of progression, especially in the presence of symptoms and/or underlying risk factors or co-morbidity. Finally, the task force concluded that there are no data to support treating SHyper in younger asymptomatic patients with grade 1 SHyper. These patients should be followed without treatment due to the low risk of progression to overt hyperthyroidism and the weaker evidence for adverse health outcomes.