This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cooper, D. S. Search for Related Content PubMed PubMed Citation Articles by Cooper, D. S. Related Collections Calcium and Bone Metabolism Cardiovascular Endocrinology Thyroid

Approach to the Patient with Subclinical Hyperthyroidism

Division of Endocrinology, Sinai Hospital of Baltimore, and The Johns Hopkins University School of Medicine, Baltimore, Maryland 21215

Address all correspondence and requests for reprints to: David S. Cooper, M.D., Division of Endocrinology, Sinai Hospital of Baltimore, 2435 West Belvedere Avenue, Hoffberger Building, Suite 56, Baltimore, Maryland 21215. E-mail dcooper{at}lifebridgehealth.org.

Endogenous subclinical hyperthyroidism, defined by normal circulating levels of free T₄ and T₃ and low levels of TSH, is a common clinical entity and is typically caused by the same conditions that account for the majority of cases of overt hyperthyroidism: Graves’ disease, toxic multinodular goiter, and solitary autonomously functioning thyroid nodules. Subclinical hyperthyroidism has been associated with an increased risk of atrial fibrillation and mortality, decreased bone mineral density in postmenopausal women, and mild hyperthyroid symptoms. Treatment of subclinical hyperthyroidism remains controversial, given the lack of prospective randomized controlled trials showing clinical benefit with restoration of the euthyroid state. Nevertheless, it seems reasonable to treat older individuals whose serum TSH levels are less than 0.1 mU/liter and certain high-risk patients, even when the serum TSH is between 0.1 and the lower limit of the normal range.

This article has been cited by other articles:

				B. Biondi and D. S. Cooper The Clinical Significance of Subclinical Thyroid Dysfunction Endocr. Rev., February 1, 2008; 29(1): 76 - 131. [Abstract] [Full Text] [PDF]