TSH 是原发性甲状腺功能减退症筛查所需的唯一检查方法。[14]Ladenson PW, Singer PA, Ain KB, et al. American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med. 2000;160:1573-1575.http://www.endo.org/club/ata.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/10847249?tool=bestpractice.com 在美国,法律规定所有的新生儿都要进行原发性甲状腺功能减退症筛查以防止智力低下。[14]Ladenson PW, Singer PA, Ain KB, et al. American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med. 2000;160:1573-1575.http://www.endo.org/club/ata.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/10847249?tool=bestpractice.com 一些专家建议筛查所有成年人,尤其是女性,从 35 岁开始,每 5 年筛查一次。[14]Ladenson PW, Singer PA, Ain KB, et al. American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med. 2000;160:1573-1575.http://www.endo.org/club/ata.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/10847249?tool=bestpractice.com 然而,美国预防服务工作组 (US Preventive Services Task Force) 认定没有足够证据支持建议或反对针对无症状的非妊娠成人进行甲状腺疾病筛查。[16]US Preventive Task Force. Screening for thyroid disease: recommendation statement. Ann Intern Med. 2004;140:125-127.http://www.annals.org/cgi/reprint/140/2/125.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/14734336?tool=bestpractice.com[17]Rugge JB, Bougatsos C, Chou R. Screening and treatment of thyroid dysfunction: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162:35-45.http://annals.org/article.aspx?articleid=1919872http://www.ncbi.nlm.nih.gov/pubmed/25347444?tool=bestpractice.com 关于筛查的其他推荐是基于专家意见。[13]American Association of Clinical Endocrinologists; American Thyroid Association. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. 2012. http://www.aace.com (last accessed 18 May 2017).https://www.aace.com/files/final-file-hypo-guidelines.pdf[18]Jonklaas J, Bianco AC, Bauer AJ, et al. Guidelines for the treatment of hypothyroidism: prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement. Thyroid. 2014;24:1670-1751.http://online.liebertpub.com/doi/pdf/10.1089/thy.2014.0028http://www.ncbi.nlm.nih.gov/pubmed/25266247?tool=bestpractice.com
没有证据证明在妊娠期进行普遍筛查可改善妊娠结局,[19]Vissenberg R, van den Boogaard E, van Wely M, et al. Treatment of thyroid disorders before conception and in early pregnancy: a systematic review. Hum Reprod Update. 2012;18:360-373.http://www.ncbi.nlm.nih.gov/pubmed/22431565?tool=bestpractice.com[20]Spencer L, Bubner T, Bain E, et al. Screening and subsequent management for thyroid dysfunction pre-pregnancy and during pregnancy for improving maternal and infant health. Cochrane Database Syst Rev. 2015;(9):CD011263.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011263.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26387772?tool=bestpractice.com [
]How does universal screening for thyroid dysfunction during pregnancy compare with no screening for improving maternal and infant outcomes?http://cochraneclinicalanswers.com/doi/10.1002/cca.1096/full显示答案不过,对甲状腺功能减退症风险升高的妊娠女性进行靶向筛查似乎应谨慎。[21]Reid SM, Middleton P, Cossich MC, et al. Interventions for clinical and subclinical hypothyroidism pre-pregnancy and during pregnancy. Cochrane Database Syst Rev. 2013;(5):CD007752.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007752.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/23728666?tool=bestpractice.com[22]Negro R, Schwartz A, Gismondi R, et al. Universal screening versus case finding for detection and treatment of thyroid hormonal dysfunction during pregnancy. J Clin Endocrinol Metab. 2010;95:1699-1707.http://www.ncbi.nlm.nih.gov/pubmed/20130074?tool=bestpractice.com 这包括具有甲状腺疾病或甲状腺过氧化物酶抗体史、甲状腺疾病家族史、甲状腺功能减退症的症状、缺碘风险、I 型糖尿病、复发性流产或头颈放射治疗史的患者。理想情况下,应使用妊娠期和人群特异性参考范围来定义妊娠期的血清 TSH 浓度的升高。[15]Alexander EK, Pearce EN, Brent GA, et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017;27:315-389.http://online.liebertpub.com/doi/pdfplus/10.1089/thy.2016.0457http://www.ncbi.nlm.nih.gov/pubmed/28056690?tool=bestpractice.com