老年亚临床甲状腺功能减退症的诊治分析  

Diagnosis and treatment of subclinical hypothyroidism in elderly patients

作　　者：顾芹[1] 陈芳[1] 蒋翠萍[1] 陈一[2] 孙皎[1] 

机构地区：[1]复旦大学附属华东医院内分泌科,上海市200040 [2]复旦大学附属华东医院康复科,上海市200040

出　　处：《老年医学与保健》2010年第1期23-24,38,共3页Geriatrics & Health Care

摘　　要：目的分析老年亚临床甲状腺功能减退症（亚甲减）患者的临床表现及甲状腺激素替代治疗后疗效及不良反应，从而探讨老年亚甲减的治疗方案。方法选择华东医院2007年4月至2009年5月门诊诊断为亚甲减的老年患者87例，给予左旋甲状腺素钠（L—T4）替代治疗。初始替代剂量为12．5gg／日，逐渐增加剂量，至TSH恢复正常，维持原方案治疗3个月后，复查血清FT3、FT4及sTSH水平及血清总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL）、高密度脂蛋白胆固醇（HDL）水平3观察甲状腺激素替代治疗前后临床症状、血脂的改善及不良反应。结果1．L—T4替代治疗后，51例有症状的患者38例有2种以上的症状明显改善。2．L—T4替代治疗后，TC、LDL明显下降（P〈0．05）。结论1．老年亚甲减患者的临床症状不明显，容易误诊、漏诊。2．左旋甲状腺素钠（L—T4）替代治疗能改善老年亚甲减患者的临床症状，降低TC、LDL水平。3．老年亚甲减患者的替代治疗，应从小剂量开始，注意个体化。Objective To study the clinical characteristics and early treatment of subclinical hypothyroidism in elderly patients. Methods Clinical data of 87 patients who were diagnosed with subclinical hypothyroidism and treated with low doses of levothyroxine were analyzed retrospectively. Serum lipids and symptoms were analyzed and compared after treat- ment. Results Serum total cholesterol and low density lipoprotein were significantly lower after treatment than those before treatment （P〈 0.05）, and the symptoms were ameliorated after treatment. Conclusion Low doses of levothyroxine can significantly decrease serum lipids of patients with subclinical hypothyroidism and ameliorate the symptoms.

关 键 词：老年人 亚临床甲状腺功能减退 左旋甲状腺素钠(L—T4) 

分 类 号：R581.2[医药卫生—内分泌]