Subclinical Hyperthyroidism

Karen Tsai, Angela M Leung
Endocrine Practice 2021 February 12
Subclinical hyperthyroidism (SCHyper) is a biochemical diagnosis defined by decreased serum thyroid-stimulating hormone (TSH) and normal serum thyroxine (T4) and triiodothyronine (T3) concentrations. Because SCHyper can resolve, it is recommended to repeat serum TSH, T3, and T4 concentrations in 3-6 months before confirming a diagnosis of SCHyper to consider treatment. Proposed grading systems distinguish between mild (TSH 0.1-0.4 mIU/L) and severe SCHyper (TSH <0.1 mIU/L) and are used alongside the patients' age and presence of risk factors and symptoms to guide treatment. Appropriate evaluation includes investigation of the underlying cause and assessment of an individual's risk factors, in order to determine the necessity and type of treatment that may be recommended. SCHyper may be associated with increased risks of cardiovascular-related adverse outcomes, bone loss, and in some studies, cognitive decline. Treatment may include observation without therapy, the initiation of antithyroid medications, or the pursuit of radioiodine therapy or thyroid surgery. Considerations for treatment include the etiology of the SCHyper, anticipated longterm natural history of the condition, potential benefits of correcting the thyroid dysfunction, and the risks and benefits of each treatment option. The purpose of this overview is to provide a guide for clinicians evaluating and managing SCHyper in routine clinical practice.

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