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A Step-Wise Approach to the Evaluation and Treatment of Subclinical Hyperthyroidism.
MedLine Citation:
PMID:  22784850     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objectives: To review a step-wise approach to the evaluation and treatment of subclinical hyperthyroidism.Methods: Articles published from 2007-2012 were reviewed and applied to the clinical management of subclinical hyperthyroidism.Results: Subclinical hyperthyroidism is encountered on a daily basis in clinical practice. When evaluating patients with a suppressed serum thyroid stimulating hormone (TSH) value, it is important to exclude other potential etiologies such as overt T3-toxicosis, drug effect, nonthyroidal illness, and central hypothyroidism. In younger patients with mild TSH suppression, it is acceptable to repeat testing in 3-6 months to assess for persistence before performing further diagnostic testing. In older patients or those with TSH values less than 0.1 mU/L, diagnostic testing should proceed without delay. Persistence of TSH suppression is more typical of nodular thyroid autonomy, whereas thyroiditis and mild Graves' disease frequently resolve spontaneously. The clinical consequences of subclinical hyperthyroidism such as atrial dysrhythmia, accelerated bone loss, increased fracture rate, and higher rates of cardiovascular mortality are age and severity dependent. The decision to treat subclinical hyperthyroidism is directly tied to an assessment of the potential for clinical consequences in untreated disease. Definitive therapy is generally selected for patients with nodular autonomous function whereas antithyroid drug therapy is more appropriate for mild persistent Graves' disease.Conclusions: The authors present a stepwise approach to the management of patients presenting with an isolated suppression of serum TSH, which focuses on the differential diagnosis, a prediction of the likelihood of persistence, an assessment of potential risks posed to the patient, and finally, an individualized choice of therapy.
Authors:
Vinh Q Mai; Henry B Burch
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-11
Journal Detail:
Title:  Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists     Volume:  -     ISSN:  1934-2403     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9607439     Medline TA:  Endocr Pract     Country:  -    
Other Details:
Languages:  ENG     Pagination:  1-29     Citation Subset:  -    
Affiliation:
Endocrinology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland Endocrinology Division, Uniformed Services University of Health Sciences, Bethesda, MD.
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