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Subclinical hypothyroidism and subclinical hyperthyroidism.

Vahab Fatourechi1

  • 1a Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. fatourechi.vahab@mayo.edu.

Expert Review of Endocrinology & Metabolism
|March 14, 2019
PubMed
Summary
This summary is machine-generated.

Subclinical thyroid dysfunction, characterized by normal hormone levels and abnormal thyroid-stimulating hormone (TSH), requires careful management. Treatment decisions for subclinical hypothyroidism and hyperthyroidism depend on specific TSH levels and patient factors.

Keywords:
antithyroid antibodycardiac risk factorhyperthyroidismhypothyroidismsubclinical hyperthyroidismsubclinical hypothyroidismthyroid-stimulating hormone screeningthyrotropinthyroxine therapy

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Area of Science:

  • Endocrinology
  • Internal Medicine
  • Thyroidology

Background:

  • Subclinical thyroid dysfunction is defined by normal peripheral thyroid hormone levels with abnormal serum thyroid-stimulating hormone (TSH).
  • Normal TSH reference range is 0.3-5.0 mIU/l.
  • It encompasses both subclinical hypothyroidism (elevated TSH) and subclinical hyperthyroidism (low TSH).

Purpose of the Study:

  • To outline diagnostic criteria for subclinical thyroid dysfunction.
  • To provide therapeutic recommendations based on TSH levels and clinical context.
  • To guide management strategies for patients with subclinical thyroid dysfunction.

Main Methods:

  • Review of diagnostic criteria for subclinical thyroid dysfunction.
  • Analysis of TSH levels in relation to normal reference ranges.
  • Evaluation of therapeutic interventions for subclinical hypothyroidism and hyperthyroidism.

Main Results:

  • Subclinical hypothyroidism with TSH >10 mIU/l warrants thyroxine therapy after excluding other causes.
  • TSH levels between 5.0-10.0 mIU/l suggest consideration for selective therapy.
  • Sustained subclinical hyperthyroidism (TSH <0.1 mIU/l) generally requires therapy, particularly in the elderly.

Conclusions:

  • Management of subclinical thyroid dysfunction should be individualized based on TSH levels.
  • Observation or selective therapy is advised for TSH levels between 0.1-0.3 mIU/l.
  • Timely intervention can mitigate potential risks associated with thyroid dysfunction.