Primary hypothyroidism

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 17 Aug 2025

最后更新： 25 Apr 2025

Primary hypothyroidism usually presents with nonspecific symptoms of fatigue, depression, constipation, and mild weight gain; physical exam may show dry skin, eyelid edema, and bradycardia.

Elevated thyroid-stimulating hormone and low free thyroxine confirms diagnosis of overt primary hypothyroidism.

Commonly, disease is subclinical with minimal elevation of thyroid-stimulating hormone and normal thyroxine.

Treatment is with levothyroxine; starting dose depends on age and presence of coexisting cardiac disease.

Over-treatment is uncommon but can lead to iatrogenic hyperthyroidism.

定义

Hypothyroidism is a clinical state resulting from underproduction of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). Most cases are due to primary hypothyroidism, a failure of the thyroid gland to produce thyroid hormones. Overt primary hypothyroidism is defined as thyroid-stimulating hormone (TSH) concentrations above the reference range and free thyroxine concentrations below the reference range.[1] Secondary hypothyroidism is due to underproduction of TSH by the pituitary gland.[2] Subclinical hypothyroidism is a state of mild thyroid failure, with normal levels of T4 and T3, and minimal elevation of TSH; it is usually asymptomatic.[3] Myxedema coma is a rare severe form of hypothyroidism that can lead to multiorgan failure.[2]

病史和体格检查

关键诊断因素

nonspecific symptoms

完整详情

其他诊断因素

lethargy
constipation
weight gain
depression
menstrual irregularity
dry or coarse skin
change in voice
bradycardia
hypertension
delayed relaxation of tendon reflexes
cold sensitivity
coarse hair
eyelid edema
goiter

完整详情

危险因素

iodine deficiency
female sex
middle age
family history of autoimmune thyroiditis
autoimmune disorders
treatment for thyroid disease
postpartum thyroiditis
Turner and Down syndromes
type 1 diabetes
radiation therapy to head and neck
infiltrative disease
iodine excess
exposure to pesticides
amiodarone use
lithium use
laryngectomy
treatment for multidrug-resistant tuberculosis (TB)

完整详情

诊断性检查

首要检查

serum thyroid-stimulating hormone (TSH)

完整详情

Tests to avoid

thyroid ultrasound

完整详情

需考虑的检查

free serum thyroxine (T4)
antithyroid peroxidase antibodies (anti-TPOAbs)
CBC
fasting blood glucose
serum cholesterol

完整详情

治疗流程

持续性治疗

confirmed overt primary hypothyroidism

subclinical hypothyroidism

撰稿人

作者

Wail Malaty, MD

Adjunct Clinical Professor

Department of Family Medicine

University of North Carolina

Chapel Hill

利益声明

WM declares that he has no competing interests.

同行评议者

Sun Y. Lee, MD, MSc

Assistant Professor of Medicine

Boston University School of Medicine

Boston

利益声明

SYL declares that she has no competing interests.

Salman Razvi, MD, FRCP

Consultant Endocrinologist

Queen Elizabeth Hospital

Gateshead

利益声明

SR declares that he has no competing interests.

Lakdasa Premawardhana, MBBS, FRCP, FRCPE

Consultant Physician

Caerphilly Miners' Hospital

Caerphilly

利益声明

LP declares that he has no competing interests.

Birte Nygaard, MD, PhD

Associated Professor

Consultant Endocrinologist

Herlev Hospital

University of Copenhagen

Denmark

利益声明

BN declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Taylor PN, Medici MM, Hubalewska-Dydejczyk A, et al. Hypothyroidism. Lancet. 2024 Oct 5;404(10460):1347-64. 摘要

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 Mar;27(3):315-89.全文摘要

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. Endocr Pract. 2012 Nov-Dec;18(6):988-1028.全文摘要

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 Dec;24(12):1670-751.全文摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Central or secondary hypothyroidism
- Depression
- Alzheimer dementia
More Differentials
Guidelines
- Thyroid function testing in the diagnosis and monitoring of thyroid function disorder
- Thyroid disease in pregnancy
More Guidelines
Patient information
Underactive thyroid
Underactive thyroid: questions to ask your doctor
More Patient information
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Primary hypothyroidism

小结

定义

病史和体格检查

关键诊断因素

其他诊断因素

危险因素

诊断性检查

首要检查

Tests to avoid

需考虑的检查

治疗流程

confirmed overt primary hypothyroidism

subclinical hypothyroidism

撰稿人

作者

Wail Malaty, MD

利益声明

同行评议者

Sun Y. Lee, MD, MSc

利益声明

Salman Razvi, MD, FRCP

利益声明

Lakdasa Premawardhana, MBBS, FRCP, FRCPE

利益声明

Birte Nygaard, MD, PhD

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice