Document Detail

An analysis of the natural course of subclinical hyperthyroidism.
MedLine Citation:
PMID:  19402203     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Our aim was to evaluate the incidence rate of overt hyperthyroidism in a cohort of patients with subclinical hyperthyroidism and to assess the potential risk factors for the development of overt thyroid hyperfunction. METHODS: We performed a retrospective analysis in 75 patients (68 women, mean age 62.2 +/- 14.2 years) with subclinical hyperthyroidism and different grades of serum thyrotropin (TSH) suppression. Incidence rate of overt hyperthyroidism and survival time, ie, time without requiring therapy for overt hyperthyroidism, were studied. RESULTS: Thirty-four patients (45.3%) developed overt hyperthyroidism and 15 (20.0%) reverted to normal TSH values. The incidence rate of overt hyperthyroidism was 9.69 cases per 100 patient-year in the whole population and 4.12, 7.41, and 29.63 cases per 100 patient-year in subjects with initial TSH values of 0.30 to 0.49, 0.10 to 0.29, and <0.10 mU/L, respectively. Kaplan-Meier analysis of survival time curves showed that the development of overt thyroid hyperfunction was significantly related to the presence of symptoms of hyperthyroidism (P < 0.05) and low (<0.10 mU/L) TSH concentrations (P < 0.001). A stepwise multivariate Cox regression analysis showed that both symptoms and low TSH values were significant factors for progression to overt thyrotoxicosis. CONCLUSIONS: TSH concentration is the most powerful predictor in the outcome of patients with subclinical hyperthyroidism. Our results suggest that patients with values under 0.10 mU/L have the highest probability to develop overt thyroid hyperfunction. In patients with TSH values higher than this value, the risk of progression is notably lower.
Juan J Díez; Pedro Iglesias
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of the medical sciences     Volume:  337     ISSN:  0002-9629     ISO Abbreviation:  Am. J. Med. Sci.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-28     Completed Date:  2009-05-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370506     Medline TA:  Am J Med Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  225-32     Citation Subset:  AIM; IM    
Department of Endocrinology , Hospital Ramón y Cajal, Madrid, Spain.
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MeSH Terms
Disease Progression
Hyperthyroidism / blood*,  diagnosis,  epidemiology*,  physiopathology
Kaplan-Meiers Estimate
Middle Aged
Proportional Hazards Models
Retrospective Studies
Risk Factors
Thyroid Gland / physiopathology
Thyrotropin / blood*
Thyroxine / blood
Triiodothyronine / blood
Reg. No./Substance:
6893-02-3/Triiodothyronine; 7488-70-2/Thyroxine; 9002-71-5/Thyrotropin

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