Observations concerning the natural history of subclinical hyperthyroidism.
OBJECTIVE
To examine the natural history of a subnormal serum thyroid-stimulating hormone (TSH) concentration with normal concentrations of both serum free thyroxine (FT4) and free triiodothyronine (FT3) (subclinical hyperthyroidism). PATIENTS, DESIGN, AND MEASUREMENTS: A retrospective analysis was undertaken and yielded 16 ambulatory patients who had presented with subclinical hyperthyroidism and were longitudinally followed with measurements of serum TSH and both FT4 and FT3 for a cumulative follow-up of 11 to 36 months. Seven of the patients had subclinical Graves' hyperthyroidism as judged from the presence of thyroid-stimulating immunoglobulins (TSI) in serum, and 9 had multinodular goiter confirmed with ultrasound and no TSI.


RESULTS
In the 7 patients with TSI, serum TSH reverted to normal in 5 patients, with disappearance or decrease of TSI in 4, within 3 to 19 months. In 1 patient, subnormal serum TSH accompanied by both normal FT4 and FT3 has persisted for 15 months, and in a second patient serum TSH reverted to normal within 9 months, but at follow-up 27 months later overt hyperthyroidism had emerged. In the 9 patients with multinodular goiter, subnormal serum TSH accompanied by both normal FT4 and FT3 persisted during cumulative follow-up that ranged from 11 to 36 months.


CONCLUSIONS
This study suggests that the natural history of subclinical hyperthyroidism is variable, resolving or occasionally evolving in subclinical Graves' disease and persisting unchanged in multinodular goiter.
Woeber
Kenneth A
KA
University of California, San Francisco, San Francisco, California 94143-1640, USA. woeber@itsa.ucsf.edu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006044:Goiter, Nodular / Q000097:blood / Q000503:physiopathology*; D006111:Graves Disease / Q000097:blood / Q000503:physiopathology*; D006801:Humans; D006980:Hyperthyroidism / Q000097:blood / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood
D014284:Triiodothyronine; D013972:Thyrotropin; D013974:Thyroxine