A stepwise approach to the evaluation and treatment of subclinical hyperthyroidism.
OBJECTIVE
To review a stepwise approach to the evaluation and treatment of subclinical hyperthyroidism.


METHODS
English-language articles regarding clinical management of subclinical hyperthyroidism published between 2007 and 2012 were reviewed.


RESULTS
Subclinical hyperthyroidism is encountered on a daily basis in clinical practice. When evaluating patients with a suppressed serum thyrotropin value, it is important to exclude other potential etiologies such as overt triiodothyronine toxicosis, drug effect, nonthyroidal illness, and central hypothyroidism. In younger patients with mild thyrotropin suppression, it is acceptable to perform testing again in 3 to 6 months to assess for persistence before performing further diagnostic testing. In older patients or patients with thyrotropin values less than 0.1 mIU/L, diagnostic testing should proceed without delay. Persistence of thyrotropin suppression is more typical of nodular thyroid autonomy, whereas thyroiditis and mild Graves disease frequently resolve spontaneously. The clinical consequences of subclinical hyperthyroidism, such as atrial dysrhythmia, accelerated bone loss, increased fracture rate, and higher rates of cardiovascular mortality, are dependent on age and severity. The decision to treat subclinical hyperthyroidism is directly tied to an assessment of the potential for clinical consequences in untreated disease. Definitive therapy is generally selected for patients with nodular autonomous function, whereas antithyroid drug therapy is more appropriate for mild, persistent Graves disease.


CONCLUSIONS
The presented stepwise approach to the care of patients presenting with an isolated suppression of serum thyrotropin focuses on the differential diagnosis, a prediction of the likelihood of persistence, an assessment of potential risks posed to the patient, and, finally, a personalized choice of therapy.
Endocrinology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland Endocrinology Division, Uniformed Services University of Health Sciences, Bethesda, Maryland 20889, USA.
Vinh Q
VQ
Mai
Henry B
HB
Burch
D000368:Aged; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D013972:Thyrotropin / Q000627:therapeutic use
D013972:Thyrotropin