心律失常或各种骨折的风险:来自观察性研究的中等质量证据表明,内源性[27]Vadiveloo T, Donnan PT, Cochrane L, et al. The Thyroid Epidemiology, Audit, and Research Study (TEARS): morbidity in patients with endogenous subclinical hyperthyroidism. J Clin Endocrinol Metab. 2011;96:1344-1351.http://www.ncbi.nlm.nih.gov/pubmed/21346066?tool=bestpractice.com或外源性[36]Flynn RW, Bonellie SR, Jung RT, et al. Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy. J Clin Endocrinol Metab. 2010;95:186-193.http://www.ncbi.nlm.nih.gov/pubmed/19906785?tool=bestpractice.com甲状腺功能亢进引起的促甲状腺激素 (TSH) 抑制会增加心律失常的风险。内源性甲状腺功能亢进的骨折风险尚不清楚,[27]Vadiveloo T, Donnan PT, Cochrane L, et al. The Thyroid Epidemiology, Audit, and Research Study (TEARS): morbidity in patients with endogenous subclinical hyperthyroidism. J Clin Endocrinol Metab. 2011;96:1344-1351.http://www.ncbi.nlm.nih.gov/pubmed/21346066?tool=bestpractice.com但一项 meta 分析表明,低水平的血清 TSH 与骨折风险增高有关。[37]Blum MR, Bauer DC, Collet TH, et al. Subclinical thyroid dysfunction and fracture risk: a meta-analysis. JAMA. 2015;313:2055-2065.http://www.ncbi.nlm.nih.gov/pubmed/26010634?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
心律失常或各种骨折的风险:来自观察性研究的中等质量证据表明,内源性[27]Vadiveloo T, Donnan PT, Cochrane L, et al. The Thyroid Epidemiology, Audit, and Research Study (TEARS): morbidity in patients with endogenous subclinical hyperthyroidism. J Clin Endocrinol Metab. 2011;96:1344-1351.http://www.ncbi.nlm.nih.gov/pubmed/21346066?tool=bestpractice.com或外源性[36]Flynn RW, Bonellie SR, Jung RT, et al. Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy. J Clin Endocrinol Metab. 2010;95:186-193.http://www.ncbi.nlm.nih.gov/pubmed/19906785?tool=bestpractice.com甲状腺功能亢进引起的促甲状腺激素 (TSH) 抑制会增加心律失常的风险。内源性甲状腺功能亢进的骨折风险尚不清楚,[27]Vadiveloo T, Donnan PT, Cochrane L, et al. The Thyroid Epidemiology, Audit, and Research Study (TEARS): morbidity in patients with endogenous subclinical hyperthyroidism. J Clin Endocrinol Metab. 2011;96:1344-1351.http://www.ncbi.nlm.nih.gov/pubmed/21346066?tool=bestpractice.com但一项 meta 分析表明,低水平的血清 TSH 与骨折风险增高有关。[37]Blum MR, Bauer DC, Collet TH, et al. Subclinical thyroid dysfunction and fracture risk: a meta-analysis. JAMA. 2015;313:2055-2065.http://www.ncbi.nlm.nih.gov/pubmed/26010634?tool=bestpractice.com
儿童患者中功能亢进型结节的恶性肿瘤风险:来自波兰的一项研究的低质量观察性研究表明:在碘缺乏地区,补充碘之后,儿童患者中甲状腺热结节的恶性肿瘤风险为 29% (9/31)。这些数据是否能沿用到碘充足地区尚不确定。[4]Niedziela M, Breborowicz D, Trejster E, et al. Hot nodules in children and adolescents in western Poland from 1996 to 2000: clinical analysis of 31 patients. J Pediatr Endocrinol Metab. 2002;15:823-830.http://www.ncbi.nlm.nih.gov/pubmed/12099393?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
儿童患者中功能亢进型结节的恶性肿瘤风险:来自波兰的一项研究的低质量观察性研究表明:在碘缺乏地区,补充碘之后,儿童患者中甲状腺热结节的恶性肿瘤风险为 29% (9/31)。这些数据是否能沿用到碘充足地区尚不确定。[4]Niedziela M, Breborowicz D, Trejster E, et al. Hot nodules in children and adolescents in western Poland from 1996 to 2000: clinical analysis of 31 patients. J Pediatr Endocrinol Metab. 2002;15:823-830.http://www.ncbi.nlm.nih.gov/pubmed/12099393?tool=bestpractice.com
症状改善:低质量证据对不同β受体阻滞剂在甲状腺毒症治疗中的效果进行了比较。普萘洛尔是传统的首选药物,但很少有数据能说明其对药物性阻断甲腺原氨酸脱碘的理论优势。[21]Perrild H, Hansen JM, Skovsted L, et al. Different effects of propranolol, alprenolol, sotalol, atenolol and metoprolol on serum T3 and serum rT3 in hyperthyroidism. Clin Endocrinol (Oxf). 1983;18:139-142.http://www.ncbi.nlm.nih.gov/pubmed/6133659?tool=bestpractice.com[22]Cooper DS, Daniels GH, Ladenson PW, et al. Hyperthyroxinemia in patients treated with high-dose propranolol. Am J Med.1982;73:867-871.http://www.ncbi.nlm.nih.gov/pubmed/6816067?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
症状改善:低质量证据对不同β受体阻滞剂在甲状腺毒症治疗中的效果进行了比较。普萘洛尔是传统的首选药物,但很少有数据能说明其对药物性阻断甲腺原氨酸脱碘的理论优势。[21]Perrild H, Hansen JM, Skovsted L, et al. Different effects of propranolol, alprenolol, sotalol, atenolol and metoprolol on serum T3 and serum rT3 in hyperthyroidism. Clin Endocrinol (Oxf). 1983;18:139-142.http://www.ncbi.nlm.nih.gov/pubmed/6133659?tool=bestpractice.com[22]Cooper DS, Daniels GH, Ladenson PW, et al. Hyperthyroxinemia in patients treated with high-dose propranolol. Am J Med.1982;73:867-871.http://www.ncbi.nlm.nih.gov/pubmed/6816067?tool=bestpractice.com
治疗结果:低质量证据比较了不同疗法用于毒性多结节性甲状腺肿 (MNG) 中的治疗结果。确定治疗方法时要考虑症状(例如,压迫)、共病、恶性肿瘤或并发症的风险。[26]Porterfield JR Jr, Thompson GB, Farley DR, et al. Evidence-based management of toxic multinodular goiter (Plummer's Disease). World J Surg. 2008;32:1278-1284.http://www.ncbi.nlm.nih.gov/pubmed/18357484?tool=bestpractice.com
系统评价或者受试者>200名的随机对照临床试验(RCT)。
治疗结果:低质量证据比较了不同疗法用于毒性多结节性甲状腺肿 (MNG) 中的治疗结果。确定治疗方法时要考虑症状(例如,压迫)、共病、恶性肿瘤或并发症的风险。[26]Porterfield JR Jr, Thompson GB, Farley DR, et al. Evidence-based management of toxic multinodular goiter (Plummer's Disease). World J Surg. 2008;32:1278-1284.http://www.ncbi.nlm.nih.gov/pubmed/18357484?tool=bestpractice.com