ТИРОНЕТ – все о щитовидной железе Для специалистов Журнал Тиронет Архив журнала 2000 год № 3

Скрининговые обследования для выявления заболеваний щитовидной железы. Часть I. Обзор литературы.

М. Гельфанд и К.С. Редферн (Helfand M., Redfern C.C.)
Clinical guideline. Screening for thyroid disease: an update. Ann Intern Med 1998;129:144 - 58.
© Перевод и публикация сделаны с разрешения Американского колледжа врачей (American College of Physicians) и авторов статьи
© Публикация на сайте ТИРОНЕТ с некоторой редакцией перевода сделана с разрешения редакции "Международного журнала медицинской практики", где впервые опубликован русский перевод статьи


  1. American College of Physicians. Guideline: screening for thyroid disease. In: Eddy D.M., ed. Common Screening Tests. Philadelphia: American Coll Physicians; 1991:179—201.
  2. Helfand M., Crapo L.M. Screening for thyroid disease. Ann Intern Med 1990;112:840—9.
  3. Eddy D.M. How to think about screening. In: Eddy D.M., ed. Common Screening Tests. Philadelphia: American Coll Physicians; 1991:1—21.
  4. Hasselblad V., McCrory D.C. Meta-analytic tools for decision-making: a practical guide. Med Decis Making 1995;15:81—96.
  5. Eddy D.M., Hasselblad V. Fast* Pro: Software for Meta-Analysis by the Confidence Profile Method. Boston: Academic Pr; 1992.
  6. Laupacis A., Sackett D.L., Roberts R.S. The assessment of clinically useful measures of the consequences of treatment. N Engl J Med 1988;318:1728—33.
  7. Helfand M. Screening for thyroid dysfunction. Advances in Endocrinology and Metabolism 1992;3:271—308.
  8. Nolan J.P., Tarsa N.J., DiBenedetto G. Case finding for unsuspected thyroid disease: costs and health benefits. Am J Clin Pathol 1985;83:346—55.
  9. Eggertsen R., Petersen K., Lundberg P.A., Nystrom E., Lindstedt G. Screening for thyroid disease in a primary care unit with a thyroid stimulating hormone assay with a low detection limit. BMJ 1988;297:1586—92.
  10. dos Remedios L.V., Weber P.M., Feldman R., Schurr D.A., Tsoi T.G. Detecting unsuspected thyroid dysfunction by the free thyroxine index. Arch Intern Med 1980;140:1045—9.
  11. Parle J.V., Franklyn J.A., Cross K.W., Jones S.C., Sheppard M.C. Prevalence and follow up of abnormal thyrotrophin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol (Oxf) 1991;34:77—83.
  12. Casas Rodriguez J., Marquet Palomer R., Grifell Martin E., Benet Marti J.M., Cortes Vargas P., Lucas A., et al. Thyrotropic hormone in an adult population seeking care at a primary health care center. Med Clin (Barc) 1990;95:89—91.
  13. Bemben D.A., Winn P., Hamm R.M., Morgan L., Davis A., Barton E. Thyroid disease in the elderly. Part 1. Prevalence of undiagnosed hypothyroidism. J Fam Pract 1994;38:577—82.
  14. Geul K.W., van Sluisveld I.L., Grobbee D.E., Docter R., de Bruyn A.M., Hooykaas H., et al. The importance of thyroid microsomal antibodies in the development of elevated serum TSH in middle aged women: associations with serum lipids. Clin Endocrinol (Oxf) 1993;39:275—80.
  15. Konno N., Makita H., Yuri K., Iizuka N., Kawasaki K. Association between dietary iodine intake and prevalence of subclinical hypothyroidism in the coastal regions of Japan. J Clin Endocrinol Metab 1994;78:393—7.
  16. Sundbeck G., Jagenburg R., Johansson P.M., Eden S., Lindstedt G. Clinical significance of low serum thyrotropin concentration by chemiluminometric assay in 85-year-old women and men. Arch Intern Med 1991;151:549—56.
  17. Sundbeck G., Lundberg P.A., Lindstedt G., Jagenburg R., Eden S. Incidence and prevalence of thyroid disease in elderly women: results from the longitudinal population study of elderly people in Gothenburg, Sweden. Age Ageing 1991;20:291—8.
  18. Bjoro T., Frey H.M., Larsen I.F., Brochmann H., Hanson F., Gaarder P.I. [Thyroid dysfunction and thyroid antibodies in a population group over the age of 70. A prevalence study from Oslo and Nжrшy.] Tidsskr Nor Laegeforen 1989;109:1048—51.
  19. Hintze G., Burghardt U., Baumert J., Windeler J., Kobberling J. Prevalence of thyroid dysfunction in elderly subjects from the general population in an iodine deficiency area. Aging (Milano) 1991;3:325—31.
  20. Schaaf L., Pohl T., Schmidt R., Vardali I., Teuber J., Schlote-Sauter B., et al. Screening for thyroid disorders in a working population. Clin Investig 1993;71:126—31.
  21. Berlowitz I., Ramot Y., Rosenberg T., Gilboa Y. Prevalence of thyroid disorders among the elderly in Israel. Isr J Med Sci 1990;26:496—8.
  22. Edwards Y., Davies T.R. Usefulness of blood tests carried out during screening of the elderly population in one practice. Br J Gen Pract 1991;41:496—8.
  23. Tunbridge W.M., Evered D.C., Hall R., Appleton D., Brewis M., Clark F., et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol (Oxf) 1977;7:481—93.
  24. Nystrom E., Bengtsson C., Lindquist O., Noppa H., Lindstedt G., Lundberg P.A. Thyroid disease and high concentration of serum thyrotrophin in a population sample of women. A 4-year follow-up. Acta Med Scand 1981;210:39—46.
  25. Okamura K., Ueda K., Sone H., Ikenoue H., Hasuo Y., Sato K., et al. A sensitive thyroid stimulating hormone assay for screening of thyroid functional disorder in elderly Japanese. J Am Geriatr Soc 1989;37:317—22.
  26. Brochmann H., Bjoro T., Gaarder P., Hanson F., Frey H.M. Prevalence of thyroid dysfunction in elderly subjects. A randomized study in a Norwegian rural community (Naeroy). Acta Endocrinol (Copenh) 1988;117:7—12.
  27. Eden S., Sundbeck G., Lindstedt G., Lundberg P.A., Jagenburg R., Landahl S., et al. Screening for thyroid disease in the elderly: serum concentrations of thyrotropin and 3,5,3' triiodothyronine in a representative population of 79-year-old women and men. Compr Gerontol [A] 1988;2:40—5.
  28. Salabe-Lotz H., Salabe G.B. Population survey of thyroid autoimmunity in Italy. Three year follow up. Thyroidology 1990; 2:107—12.
  29. Nyström E., Petersen K., Lindstedt G., Lundberg P.A. Screening for thyroid disease in women greater than or equal to 50 years of age seeking hospital care: influence of common nonthyroidal illness on serum free thyroxin as determined by analog radioimmunoassay. Clin Chem 1986;32:603—8.
  30. Kagedal B., Manson J.C., Norr A., Sorbo B., Tegler L. Screening for thyroid disorders in middle-aged women by computer-assisted evaluation of a thyroid hormone panel. Scand J Clin Lab Invest 1981;41:403—8.
  31. Christensen S.B., Ericsson U.B., Janzon L., Tibblin S., Trell E. The prevalence of thyroid disorders in a middle-aged female population, with special reference to the solitary thyroid nodule. Acta Chir Scand 1984;150:13—9.
  32. Spencer C.A., Takeuchi M., Kazarosyan M., MacKenzie F., Beckett G.J., Wilkonson E. Interlaboratory/intermethod differences in functional sensitivity of immunometric assays of thyrotropin (TSH) and impact on reliability of measurement of subnormal concentrations of TSH. Clin Chem 1995;41:367—74.
  33. Petersen K., Lindstedt G., Lundberg P.A., Bengtsson C., Lapidus L., Nystrцm E. Thyroid disease in middle-aged and elderly Swedish women: thyroid-related hormones, thyroid dysfunction and goitre in relation to age and smoking. J Intern Med 1991;229:407—13.
  34. Stott D.J., McLellan A.R., Finlayson J., Chu P., Alexander W.D. Elderly patients with suppressed serum TSH but normal free thyroid hormone levels usually have mild thyroid overactivity and are at increased risk of developing overt hyperthyroidism. Q J Med 1991;78:77—84.
  35. Tenerz A., Forberg R., Jansson R. Is a more active attitude warranted in patients with subclinical thyrotoxicosis? J Intern Med 1990;228:229—33.
  36. Helfand M., Crapo L.M. Testing for suspected thyroid dysfunction. In: Sox H.C. Jr., ed. Common diagnostic tests: use and interpretation, 2d ed. Philadelphia: American Coll Physicians; 1990:148—82.
  37. Wiersinga W.M. Subclinical hypothyroidism and hyperthyroidism. I. Prevalence and clinical relevance. Neth J Med 1995;46: 197—204.
  38. Sawin C.T., Geller A., Wolf P.A., Belanger A.J., Baker E., Bacharach P., et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med 1994;331:1249—52.
  39. Wedja B., Hintze G., Katschinski B., Olbricht T., Benker G. Hip fractures and the thyroid: a case-control study. J Intern Med 1995;237:241—7.
  40. Foldes J., Tarjan G., Szathmari M., Varga F., Krasznai I., Horvath C. Bone mineral density in patients with endogenous subclinical hyperthyroidism: is this thyroid status a risk factor for osteoporosis? Clin Endocrinol (Oxf) 1993;39:521—7.
  41. Mudde A.H., Reijnders F.J., Kruseman A.C. Peripheral bone density in women with untreated multinodular goitre. Clin Endocrinol (Oxf) 1992;37:35—9.
  42. Bauer D.C., Ettinger B., Nevitt M.C., Stone K.L., Cummings S.R. Women with low serum TSH have an increased risk of hip and vertebral fractures: a prospective study. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 1995;10.
  43. Danese M.D., Powe N.R., Sawin C.T., Ladenson P.W. Screening for mild thyroid failure at the periodic health examination: a decision and cost-effectiveness analysis. JAMA 1996;276:285—92.
  44. Canadian Task Force on the Periodic Health Examination. The Canadian Guide to Clinical Preventive Health Care. Ottawa: Canada Communication Group; 1994:611—8.
  45. Glenn G.C. Practice parameters on laboratory panel testing for screening and case finding in asymptomatic adults. The Laboratory Testing Strategy Task Force of the College of American Pathologists. Arch Pathol Lab Med 1996;120:929—43.
  46. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Report of the U.S. Preventive Services Task Force, 2d ed. Washington, DC: US Gov Pr Office; 1996.
  47. Franklyn J. "Subclinical hypothyroidism": to treat or not to treat, that is the question. Clin Endocrinol (Oxf) 1995;43:443—4.
  48. Cooper D.S., Halpern R., Wood L.C., Levin A.A., Ridgway E.C. L-thyroxine therapy in subclinical hypothyroidism. A double-blind, placebo-controlled trial. Ann Intern Med 1984;101:18—24.
  49. Nystrцm E., Caidahl K., Fager G., Wikkelso C., Lundberg P.A., Lindstedt G. A double-blind cross-over 12-month study of L-thyroxine treatment of women with "subclinical" hypothyroidism. Clin Endocrinol (Oxf) 1988;29:63—75.
  50. Jaeschke R., Guyatt G., Gerstein H., Patterson C., Molloy W., Cook D., et al. Does treatment with L-thyroxine influence health status in middle-aged and older adults with subclinical hypothyroidism? J Gen Intern Med 1996;11:744—9.
  51. Guyatt G.H., Naylor C.D., Juniper E., Heyland D.K., Jaeschke R., Cook D.J. Users' guides to the medical literature. XII. How to use articles about health-related quality of life. Evidence-Based Medicine Working Group. JAMA 1995;277:1232—7.
  52. Andresen E.M., Patrick D.L., Carter W.B., Malmgren J.A. Comparing the performance of health status measures for healthy older adults. J Am Geriatr Soc 1995;43:1030—4.
  53. Tunbridge W.M., Brewis M., French J.M., Appleton D., Bird T., Clark F., et al. Natural history of autoimmune thyroiditis. Br Med J (Clin Res Ed) 1981;282:258—62.
  54. Vanderpump M.P., Tunbridge W.M., French J.M., Appleton D., Bates D., Clark F., et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995;43:55—68.
  55. Parle J.V., Franklyn J.A., Cross K.W., Jones S.R., Sheppard M.C. Circulating lipids and minor abnormalities of thyroid function. Clin Endocrinol (Oxf) 1992;37:411—4.
  56. Valdemarsson S., Hansson P., Hedner P., Nilsson-Ehle P. Relations between thyroid function, hepatic and lipoprotein lipase activities, and plasma lipoprotein concentrations. Acta Endocrinol (Copenh) 1983;104:50—6.
  57. Tanis B.C., Westendorp G.J., Smelt H.M. Effect of thyroid substitution on hypercholesterolaemia in patients with subclinical hypothyroidism: a reanalysis of intervention studies. Clin Endocrinol (Oxf) 1996;643—9.
  58. Bogner U., Arntz H.R., Peters H., Schleusener H. Subclinical hypothyroidism and hyperlipoproteinaemia: indiscriminate L-thyroxine treatment not justified. Acta Endocrinol (Copenh) 1993;128:202—6.
  59. Diekman T., Lansberg P.J., Kastelein J.J., Wiersinga W.M. Prevalence and correction of hypothyroidism in a large cohort of patients referred for dyslipidemia. Arch Intern Med 1995;155: 1490—5.
  60. Miura S., Iitaka M., Yoshimura H., Kitahama S., Fukasawa N., Kawakami Y., et al. Disturbed lipid metabolism in patients with subclinical hypothyroidism: effect of L-thyroxine therapy. Intern Med 1994;33:413—7.
  61. Althaus B.U., Staub J.J., Ryff-De Leche A., Oberhansli A., Stahelin H.B. LDL/HDL-changes in subclinical hypothyroidism: possible risk factors for coronary heart disease. Clin Endocrinol (Oxf) 1988;28:157—63.
  62. 1990 Census of Population and Housing. Population and Housing Characteristics for Census Tracts and Block Numbering Areas. United States. 1993. GPO stock no. 003-024-08015-0.
  63. Garber A.M., Browner W.S., Hulley S.B. Cholesterol screening in asymptomatic adults, revisited. Part 2. Ann Intern Med 1996;124:518—31.
  64. Corti M.C., Guralnik J.M., Salive M.E., Harris T., Ferrucci L., Glynn R.J., et al. Clarifying the direct relation between total cholesterol levels and death from coronary heart disease in older persons. Ann Intern Med 1997;126:753—60.
  65. Arem R., Patsch W. Lipoprotein and apolipoprotein levels in subclinical hypothyroidism. Effect of levothyroxine therapy. Arch Intern Med 1990;150:2097—100.
  66. Franklyn J.A., Daykin J., Betteridge J., Hughes E.A., Holder R., Jones S.R., et al. Thyroxine replacement therapy and circulating lipid concentrations. Clin Endocrinol (Oxf) 1993;38:453—9.
  67. Kannel W.B. Prevalence, incidence, and mortality of coronary heart disease. In: Fuster V., Ross R., Topol E.J., eds. Atherosclerosis and Coronary Artery Disease. Philadelphia: Lippincott-Raven; 1996:13—21.
  68. Bannister P., Barnes I. Use of sensitive thyrotrophin measurements in an elderly population. Gerontology 1989;35:225—9.
  69. Sawin C.T., Geller A., Kaplan M.M., Bacharach P., Wilson P.W., Hershman J.M. Low serum thyrotropin (thyroid-stimulating hormone) in older persons without hyperthyroidism. Arch Intern Med 1991;151:165—8.
  70. Uzzan B., Campos J., Cucherat M., Nony P., Boissel J.P., Perret G.Y. Effects on bone mass of long term treatment with thyroid hormones: a meta-analysis. J Clin Endocrinol Metab 1996;81:4278—89.
  71. Ching G.W., Franklyn J.A., Stallard T.J., Daykin J., Sheppard M.C., Gammage M.D. Cardiac hypertrophy as a result of long-term thyroxine therapy and thyrotoxicosis. Heart 1996;75:363—8.
  72. Hayward R.S., Steinberg E.P., Ford D.E., Roizen M.F., Roach K.W. Preventive care guidelines: 1991. American College of Physicians. Canadian Task Force on the Periodic Health Examination. United States Preventive Services Task Force. Ann Intern Med 1991;114:758—83.
  73. Guyatt G.H., Sackett D.L., Sinclair J.C., Hayward R., Cook D.J., Cook R.J. Users' guides to the medical literature. IX. A method for grading health care recommendations. Evidence-Based Medicine Working Group. JAMA 1995;274:1800—4.