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Management of Subclinical Hyperthyroidism

AUTHORS

Silvia Santos Palacios 1 , Eider Pascual-Corrales 1 , Juan Carlos Galofre 1 , *

1 Department of Endocrinology and Nutrition, University Clinic of Navarra, University of Navarra, jcgalofre@unav.es, Spain

How to Cite: Santos Palacios S, Pascual-Corrales E, Galofre J C. Management of Subclinical Hyperthyroidism, Int J Endocrinol Metab. Online ahead of Print ; 10(2):490-496. doi: 10.5812/ijem.3447.

ARTICLE INFORMATION

International Journal of Endocrinology and Metabolism: 10 (2); 490-496
Published Online: December 1, 2012
Article Type: Review Article
Received: November 7, 2011
Accepted: April 20, 2011
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Abstract

The ideal approach for adequate management of subclinical hyperthyroidism (low levels of thyroid-stimulating hormone [TSH] and normal thyroid hormone level) is a matter of intense debate among endocrinologists. The prevalence of low serum TSH levels ranges between 0.5% in children and 15% in the elderly population. Mild subclinical hyperthyroidism is more common than severe subclinical hyperthyroidism. Transient suppression of TSH secretion may occur because of several reasons; thus, corroboration of results from different assessments is essential in such cases. During differential diagnosis of hyperthyroidism, pituitary or hypothalamic disease, euthyroid sick syndrome, and drug-mediated suppression of TSH must be ruled out. A low plasma TSH value is also typically seen in the first trimester of gestation. Factitial or iatrogenic TSH inhibition caused by excessive intake of levothyroxine should be excluded by checking the patients medication history. If these nonthyroidal causes are ruled out during differential diagnosis, either transient or long-term endogenous thyroid hormone excess, usually caused by Graves disease or nodular goiter, should be considered as the cause of low circulating TSH levels. We recommend the following 6-step process for the assessment and treatment of this common hormonal disorder: 1) confirmation, 2) evaluation of severity, 3) investigation of the cause, 4) assessment of potential complications, 5) evaluation of the necessity of treatment, and 6) if necessary, selection of the most appropriate treatment. In conclusion, management of subclinical hyperthyroidism merits careful monitoring through regular assessment of thyroid function. Treatment is mandatory in older patients (> 65 years) or in presence of comorbidities (such as osteoporosis and atrial fibrillation).

Keywords

Hyperthyroidism Disease Management Therapeutics Graves Disease

© 2012, International Journal of Endocrinology and Metabolism. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

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