Guía clínica del diagnóstico y tratamiento de la disfunción tiroidea subclínica

Article information

En la práctica clínica son frecuentes los pacientes con disfunción tiroidea subclínica. Es decir, pacientes con concentraciones de tirotropina (TSH) fuera de los valores de referencia pero con concentraciones de tiroxina libre y triyodotironina libre normales.

En el presente artículo, se describe qué es la disfunción tiroidea subclínica, se revisa su epidemiología, se recomienda el abordaje más apropiado, se evalúan los riesgos y beneficios del tratamiento y se establece la utilidad de su cribado en ciertos grupos de población.

En definitiva, son limitadas las evidencias que sugieren una asociación de la disfunción tiroidea subclínica con ciertos síntomas o con el beneficio o riesgos de su tratamiento. Las consecuencias de la disfunción tiroidea subclínica (TSH: 0,1-0,45 mU/l o 4,5-10 mU/l) son escasas y no se puede recomendar el tratamiento rutinario de estos pacientes. Asimismo, no se puede recomendar el cribado indiscriminado de la población. No obstante, se debe buscar con insistencia en mujeres embarazadas de riesgo, mujeres mayores de 60 años y en ciertos grupos de riesgo.

Palabras clave:

Disfunción tiroidea subclínica

Hipertiroidismo subclínico

Hipotiroidismo subclínico

Patients with serum thyroidstimulating hormone (TSH) outside the reference range and levels of free thyroxine and free triiodothyronine within the reference range are common in clinical practice. In the present article, subclinical thyroid disease is defined and its epidemiology reviewed.

Recommendations on appropriate evaluation and the risks and benefits of treatment and consequences of non-treatment are explored. The question of whether population-based screening is warranted is also discussed.

Data supporting an association between subclinical thyroid disease and symptoms or adverse clinical outcomes or benefits of treatment are scarce. The consequences of subclinical thyroid disease (serum TSH 0.1-0.45 mU/l or 4.5-10.0 mU/l) are minimal and recommendations against routine treatment of patients with TSH levels in these ranges are provided. There is insufficient evidence to support population-based screening. Nevertheless, pertinacious case finding is appropriate in pregnant women at risk, women older than 60 years, and others at high risk for thyroid dysfunction.

Key words:

Subclinical thyroid disease

Subclinical hyperthyroidism

Subclinical hypothyroidism

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