The Korean Journal of Medicine

  • 제99권3호
  • /
  • Pages.127-133
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  • 2024
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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무증상 갑상선기능저하증의 진단과 치료: 2023 대한갑상선학회 진료 권고안

Diagnosis and Management of Subclinical Hypothyroidism: The 2023 Clinical Practice Guideline, Korean Thyroid Association

  • 정현경 (단국대학교 의과대학 내과학교실)
  • Hyun-Kyung Chung (Department of Internal Medicine, Dankook University College of Medicine)
  • 투고 : 2024.03.23
  • 심사 : 2024.05.06
  • 발행 : 2024.06.01
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초록

Subclinical hypothyroidism (SCH) is characterized by elevated serum thyroid-stimulating hormone (TSH) levels and normal free thyroxine levels. The Korean Thyroid Association recently issued guidelines for managing SCH. Based on the Korea National Health and Nutrition Examination Survey (2013-2015), a serum TSH level of 6.8 mIU/L is the reference value for SCH. SCH is classified as mild (TSH 6.8-10.0 mIU/L) or severe (TSH > 10.0 mIU/L), and patients are categorized as adult (age < 70 years) or elderly (age ≥ 70 years). Levothyroxine treatment (LT4-Tx) is not recommended for mild or even severe SCH in elderly patients. Immediate LT4-Tx can be given to adults in most cases, but not to women who are pregnant, patients with progressive disease, or patients with underlying coronary artery disease, heart failure, or dyslipidemia.

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참고문헌

  1. Chung HK, Ku EJ, Yoo WS, et al. 2023 Korean Thyroid Association management guidelines for patients with subclinical hypothyroidism. Int J Thyroidol 2023;16:32-50.
  2. Kim WG, Kim WB, Woo G, et al. Thyroid stimulating hormone reference range and prevalence of thyroid dysfunction in the Korean population: Korea National Health and Nutrition Examination Survey 2013 to 2015. Endocrinol Metab (Seoul) 2017;32:106-114.
  3. Park SY, Kim HI, Oh HK, et al. Age- and gender-specific reference intervals of TSH and free T4 in an iodine-replete area: data from Korean National Health and Nutrition Examination Survey IV (2013-2015). PLoS One 2018;13:e0190738.
  4. Kim M, Kim TY, Kim SH, et al. Reference interval for thyrotropin in a ultrasonography screened Korean population. Korean J Intern Med 2015;30:335-344.
  5. Choi HS, Park YJ, Kim HK, et al. Prevalence of subclinical hypothyroidism in two population based-cohort: Ansung and KLoSHA cohort in Korea. J Korean Thyroid Assoc 2010;3:32-40.
  6. Jang YY, Kim CY, Hwang TY, Kim KD, Lee CH. Reference interval of serum thyroid hormones in healthy Korean adults. J Prev Med Public Health 2008;41:128-134.
  7. Yoo WS, Kim S, Park YJ, et al. Comparison of thyroid-stimulating hormone results from eight different reagents and assay-specific Korean reference interval for subclinical hypothyroidism treatment. Int J Thyroidol 2023;16:166-174.
  8. Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012;22:1200-1235.
  9. Peeters RP. Subclinical hypothyroidism. N Engl J Med 2017;376:2556-2565.
  10. Stott DJ, Rodondi N, Kearney PM, et al. Thyroid hormone therapy for older adults with subclinical hypothyroidism. N Engl J Med 2017;376:2534-2544.
  11. Mooijaart SP, Du Puy RS, Stott DJ, et al. Association between levothyroxine treatment and thyroid-related symptoms among adults aged 80 years and older with subclinical hypothyroidism. JAMA 2019;322:1977-1986.
  12. Rodondi N, den Elzen WP, Bauer DC, et al. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA 2010;304:1365-1374.
  13. Chaker L, Baumgartner C, den Elzen WP, et al. Subclinical hypothyroidism and the risk of stroke events and fatal stroke: an individual participant data analysis. J Clin Endocrinol Metab 2015;100:2181-2191.
  14. Gencer B, Collet TH, Virgini V, et al. Subclinical thyroid dysfunction and the risk of heart failure events: an individual participant data analysis from 6 prospective cohorts. Circulation 2012;126:1040-1049.
  15. Baumgartner C, da Costa BR, Collet TH, et al. Thyroid function within the normal range, subclinical hypothyroidism, and the risk of atrial fibrillation. Circulation 2017;136:2100-2116.
  16. Feller M, Snel M, Moutzouri E, et al. Association of thyroid hormone therapy with quality of life and thyroid-related symptoms in patients with subclinical hypothyroidism: a systematic review and meta-analysis. JAMA 2018;320:1349-1359.
  17. Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA guideline: management of subclinical hypothyroidism. Eur Thyroid J 2013;2:215-228.
  18. Razvi S, Ingoe L, Keeka G, Oates C, McMillan C, Weaver JU. The beneficial effect of L-thyroxine on cardiovascular risk factors, endothelial function, and quality of life in subclinical hypothyroidism: randomized, crossover trial. J Clin Endocrinol Metab 2007;92:1715-1723.
  19. Yi KH, Ahn HY, Kim JH, et al. 2023 revised Korean Thyroid Association guidelines for the diagnosis and management of thyroid disease during pregnancy and postpartum. Int J Thyroidol 2023;16:51-88.
  20. Mammen JS, McGready J, Oxman R, Chia CW, Ladenson PW, Simonsick EM. Thyroid hormone therapy and risk of thyrotoxicosis in community-resident older adults: findings from the baltimore longitudinal study of aging. Thyroid 2015;25:979-986.
  21. Abbey EJ, McGready J, Ferrucci L, Simonsick EM, Mammen JSR. Thyroid hormone supplementation and all-cause mortality in community-dwelling older adults: results from the Baltimore longitudinal study of aging. J Am Geriatr Soc 2021;69:1283-1290.
  22. Gavigan C, Abbey EJ, McGready J, Simonsick EM, Mammen JS. Levothyroxine dosing in older adults: recommendations derived from the Baltimore longitudinal study of aging. Endocr Pract 2023;29:612-617.