围绝经期综合征与甲状腺激素：综述

Perimenopausal Syndrome and Thyroid Hormones: A Review

摘要: 围绝经期是女性内分泌系统发生显著转折的关键阶段，此期间出现的围绝经期综合征与甲状腺功能异常在临床表现上存在广泛重叠(如疲劳、情绪波动、心悸等)，常导致临床鉴别诊断困难，可能造成误诊或治疗延误。近年来，两者之间的潜在关联日益受到关注。文章旨在通过系统综述现有文献，深入探讨围绝经期女性甲状腺功能的变化规律、这些变化与围绝经期综合征症状群的复杂关系及内在作用机制。很多研究表明随年龄增长及雌激素水平波动，女性甲状腺自身免疫阳性率升高，亚临床甲状腺功能异常患病率增加。流行病学证据提示，甲状腺功能状态与特定围绝经期症状的严重程度可能存在关联。其潜在机制涉及下丘脑–垂体–卵巢轴与下丘脑–垂体–甲状腺轴的交互影响、共同的低度炎症通路以及神经内分泌调节网络的失衡。结论认为，临床医生应提高对围绝经期女性甲状腺功能的警惕性，建议进行常规筛查以实现精准鉴别。未来的研究需通过前瞻性设计进一步明确两者的因果关系，并探索针对共病状态的个性化管理策略，以改善这部分女性的生活质量和长期健康状态。

Abstract: The perimenopausal period constitutes a critical transitional phase marked by significant shifts in the female endocrine system. The clinical manifestations of perimenopausal syndrome and thyroid dysfunction exhibit substantial overlap (e.g., fatigue, mood swings, palpitations), often leading to challenges in differential diagnosis and potentially resulting in misdiagnosis or delayed treatment. In recent years, the potential association between the two has garnered increasing attention. This article aims to systematically review existing literature to explore the patterns of thyroid function changes in perimenopausal women, the complex relationship between these changes and perimenopausal symptom clusters, and the underlying mechanisms. Numerous studies indicate that with advancing age and fluctuations in estrogen levels, the prevalence of positive thyroid autoimmunity and subclinical thyroid dysfunction increases in women. Epidemiological evidence suggests a possible correlation between thyroid functional status and the severity of specific perimenopausal symptoms. The potential mechanisms involve the crosstalk between the hypothalamic-pituitary-ovarian axis and the hypothalamic-pituitary-thyroid axis, shared low-grade inflammatory pathways, and an imbalance in the neuroendocrine regulatory network. In conclusion, clinicians should maintain a high index of suspicion for thyroid dysfunction in perimenopausal women and consider routine screening to facilitate precise differentiation. Future research should employ prospective designs to elucidate the causal relationship between these conditions further and explore personalized management strategies for their co-occurrence, with the goal of improving the quality of life and long-term health outcomes for this population.