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Subclinical Hyperthyroidism

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Thyroid Disorders

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Abstract

Because of screening tests with sensitive TSH assays, subclinical hyperthyroidism is being recognized more commonly. Subclinical hyperthyroidism is defined as undectectable thyrotrophin (TSH) concentration in patients with normal levels of T4 and T3. Subtle symptoms and signs of thyrotoxicosis may be present.

It be classified as endogenous in patients with thyroid hormone production associated with nodular thyroid disease or underlying Graves’ disease; and as exogenous in those with undectectable serum thyrotropin concentrations as a result of treatment with levothyroxine. Subclinical hyperthyroidism is often found in older subjects with autonomous function of a multinodular goiter or nodule.

Osteoporosis and atrial fibrillation are complications of subclinical hyperthyroidism that may be an indication for treatment. Studies suggest a possible increase in all-cause mortality in patients with subclinical hyperthyroidism with an increase beyond the age of 60, especially in aging men.

In many patients with endogeneous subclinical hyperthyroidism who do not have nodular thyroid disease or complications of excess thyroid hormone, treatment is unnecessary, but thyroid-function tests should be performed every 6 months. In older patients with atrial fibrillation or osteoporosis that could have been caused or exacerbated by the mild excess of thyroid hormone, ablative therapy with 131I is the best initial option.

In patients with exogeneous subclinical hyperthyroidism, the dose of levothyroxine should be reduced, excluding those with prior thyroid cancer in whom thyrotropin suppression may be required. The dose of levothyroxine used for treating hypothyroidism may be reduced if the patient develops new atrial fibrillation, angina, cardiac failure or accelerated bone loss.

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Authors and Affiliations

  1. University Diabetes Center, King Saud University, Riyadh, Saudi Arabia

    Asim Hassan FRCP, SCE/MRCP (Diab, Endo)

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  1. Internal Medicine, Al-Mouwasat Hospital, Jubail, Saudi Arabia

    Syed Khalid Imam

  2. School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom

    Shamim I. Ahmad

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Hassan, A. (2016). Subclinical Hyperthyroidism. In: Imam, S., Ahmad, S. (eds) Thyroid Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-25871-3_10

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