Subclinical Hyperthyroidism: Diagnostic Criteria and Principles of Treatment Review of European Thyroid Association Guidelines «Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism», 2015
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
This article presents the European Thyroid Association guidelines for diagnosis and treatment of subclinical hyperthyroidism, 2015. Determination of thyroid1stimulating hormone levels can help to diagnose a variety of pathological conditions: hypertension, cardiac fibrillation, atrial fibrillation, mineral density reduction in bones, menstrual irregularities, infertility, which require specific treatment after detection of hormonal status disorders (subclinical, overt), taking into account the patient’s age.
Diagnosis of endogenous subclinical hyperthyroidism is based solely on the results of laboratory tests, not clinical criteria. Endogenous subclinical hyperthyroidism is defined by the presence of subnormal levels of thyroid-stimulating hormone with normal levels of free thyroxine, total triiodothyronine, and/or free triiodothyronine. There are two categories of endogenous subclinical hyperthyroidism: stage 1 – the level of thyroid1stimulating hormone is 0,1–0,39 mIU/l; stage 2 – the level of thyroid1stimulating hormone is <0.1 mIU/l. The levels of free thyroxine and free triiodothyronine, as a rule, are medium-high value at a subclinical level of thyroid hormone and can help differentiate between endogenous subclinical hyperthyroidism from overt hyperthyroidism.
It is recommended to study the thyroid-stimulating hormone level as the first test for the diagnosis of subclinical hyperthyroidism. In identifying low levels of thyroid1stimulating hormone it is necessary to investigate the level of free thyroxine, free or bound triiodothyronine. Patients with primary subnormal levels of thyroid-stimulating hormone with concentration of thyroid hormones in the upper limit or in normal range should be evaluated within 2-3 months. It is recommended to perform scintigraphy and possible 24-hour test the absorption of radioactive iodine if in patient with 2nd degree endogenous subclinical hyperthyroidism there is nodular goiter to determine treatment strategy.
Ultrasonography with color Doppler can be informative for patients with endogenous subclinical hyperthyroidism and nodular goiter. Determining the level of antibodies to thyroid-stimulating hormone receptors can confirm the etiology of autoimmune-induced hyperthyroidism.
##plugins.themes.bootstrap3.article.details##
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain the copyright and grant the journal the first publication of original scientific articles under the Creative Commons Attribution 4.0 International License, which allows others to distribute work with acknowledgment of authorship and first publication in this journal.
References
Biondi В, Bartalena L, Cooper D S, et al. The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism. Eur Thyroid J 2015;4:149-163 DOI: 10.1159/000438750.
Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004; 291:228-238.
Biondi B, Palmieri EA, Klain M, Schlumberger M, Filetti S, Lombardi G. Subclinical hyperthyroidism: clinical features and treatment options. Eur J Endocrinol 2005;152:1-9.
Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev 2008; 29: 76-131.
Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011;21:593-646.
Cooper DS, Biondi B: Subclinical thyroid disease. Lancet 2012;379:1142-1154.
Mitchell AL, Pearce SH: How should we treat patients with low serum thyrotropin concentrations? Clin Endocrinol (Oxf) 2010;72:292-296.
Bülow Pedersen I, Knudsen N, Jшrgensen T, Perrild H, Ovesen L, Laurberg P. Large differences in incidences of overt hyper- and hypothyroidism associated with a small difference in iodine intake: a prospective comparative register-based population survey. J Clin Endocrinol Metab 2002;87:4462-4469.
Marqusee E, Haden ST, Utiger RD. Subclinical thyrotoxicosis. Endocrinol Metab Clin North Am 1998;27:37-49.
Canaris GJ, Manowitz NR, Mayor G, Ridgway EC: The Colorado thyroid disease prevalence study. Arch Intern Med 2000;160:526-534.
Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988–1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-499.
Aghini-Lombardi F, Antonangeli L, Martino E, et al: The spectrum of thyroid disorders in an iodine-deficient community: the Pescopagano survey. J Clin Endocrinol Metab 1999;84:561-566.
Paschke R, Hegedüs L, Alexander E, Valcavi R, Papini E, Gharib H: Thyroid nodule guidelines: agreement, disagreement and need for future research. Nat Rev Endocrinol 2011;7:354-361.
Baloch Z, Carayon P, Conte-Devolx B, Demers LM, Feldt-Rasmussen U, Henry JF, LiVosli VA, Niccoli-Sire P, John R, Ruf J, Smyth PP, Spencer CA, Stockigt JR; Guidelines Committee, National Academy of Clinical Biochemistry: Laboratory medicine practice guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003; 13: 3-126.
Figge J, Leinung M, Goodman AD, Izquierdo R, Mydosh T, Gates S, Line B, Lee DW: The clinical evaluation of patients with subclinical hyperthyroidism and free triiodothyronine (free T3) toxicosis. Am J Med 1994;96:229-234.
Cooper DS, Laurberg P. Hyperthyroidism in pregnancy. Lancet Diabetes Endocrinol 2013;1:238-249.
Harman SM, Wehmann RE, Blackman MR: Pituitary-thyroid hormone economy in healthy aging men: basal indices of thyroid function and thyrotropin responses to constant infusions of thyrotropin releasing hormone. J Clin Endocrinol Metab 1984;58:320-326.
Mariotti S, Franceschi C, Cossarizza A, Pinchera A. The aging thyroid. Endocr Rev 1995;16:686-715.
Surks MI, Boucai L. Age- and race-based serum thyrotropin reference limits. J Clin Endocrinol Metab 2010;95:496-502.
Magri F, Muzzoni B, Cravello L, Fioravanti M, Busconi L, Camozzi D, Vignati G, Ferrari E. Thyroid function in physiological aging and in centenarians: possible relationships with some nutritional markers. Metabolism 2002;51:105-109.
Mariotti S, Barbesino G, Caturegli P, Bartalena L, Sansoni P, Fagnoni F, Monti D, Fagiolo U, Franceschi C, Pinchera A. Complex alteration of thyroid function in healthy centenarians. J Clin Endocrinol Metab 1993;77:1130-1134.
Belin RM, Astor BC, Powe NR, Ladenson PW. Smoke exposure is associated with a lower prevalence of serum thyroid autoantibodies and thyrotropin concentration elevation and a higher prevalence of mild thyrotropin concentration suppression in the Third National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2004;89:6077-6086.
Diana T, Kanitz M, Lehmann M, Li Y, Olivo PD, Kahaly GJ. Standardization of a bioassay for thyrotropin receptor stimulating autoantibodies. Thyroid 2015;25:169-175.
Pedersen IB, Knudsen N, Perrild H, Ovesen L, Laurberg P. TSH-receptor antibody measurement for differentiation of hyperthyroidism into Graves’ disease and multinodular toxic goitre: a comparison of two competitive binding assays. Clin Endocrinol (Oxf) 2001;55:381-390.
