scholarly journals Transient high thyroid stimulating hormone and hypothyroidism incidence during follow up of subclinical hypothyroidism

2021 ◽  
Vol 55 (4) ◽  
pp. 204-214
Author(s):  
Munir Abu-Helalah ◽  
Hussam Ahmad Alshraideh ◽  
Sameeh Abdulkareem Al-Sarayreh ◽  
AbdelFattah Al-Hader
Keyword(s):  
Subclinical Hypothyroidism ◽  
Screening Program ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Free Triiodothyronine ◽  
High Prevalence ◽  
Levothyroxine Replacement ◽  
Stimulating Hormone

Abstract Objectives. Given the high prevalence of subclinical hypothyroidism (SCH), defined as high thyroid stimulating hormone (TSH) and normal free thyroxine (FT4), and uncertainty on treatment, one of the major challenges in clinical practice is whether to initiate the treatment for SCH or to keep the patients under surveillance. There is no published study that has identified predictors of short-term changes in thyroid status amongst patients with mild elevation of TSH (4.5–10 mIU/L). Subjects and Results. A cohort study was conducted on patients with SCH detected through a general population screening program, who were followed for six months. This project identified factors predicting progression to hypothyroid status, persistent SCH and transient cases. A total of 656 participants joined the study (431 controls and 225 were patients with SCH). A part of participants (12.2%) developed biochemical hypothyroidism during the follow-up, while 73.8% of the subjects became euthyroid and the remained ones (13.4%) stayed in the SCH status. The incidence of overt hypothyroidism for participants with TSH above 6.9 mIU/L was 36.7%, with incidence of 42.3% for females. Anti-thyroid peroxidase antibodies (TPO) positivity is an important predictor of development of hypothyroidism; however, it could be also positive due to transient thyroiditis. Conclusions. It can be concluded that females with TSH above 6.9 mIU/L, particularly those with free triiodothyronine (FT3) and FT4 in the lower half of the reference range, are more likely to develop biochemical hypothyroidism. Therefore, it is recommended to give them a trial of levothyroxine replacement. It is also recommended to repeat TSH after six months for male subjects and participants with baseline TSH equal or less than 6.9 mIU/L.

A rare cause of subclinical hypothyroidism: macro-thyroid-stimulating hormone

Diagnosis ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. 75-77
Author(s):  
Cem Onur Kirac ◽  
Sedat Abusoglu ◽  
Esra Paydas Hataysal ◽  
Aysegul Kebapcilar ◽  
Suleyman Hilmi Ipekci ◽  
...  
Keyword(s):  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Normal Range ◽  
Free Triiodothyronine ◽  
Case Presentation ◽  
Chronic Autoimmune Thyroiditis ◽  
Levothyroxine Replacement ◽  
Tsh Levels ◽  
Stimulating Hormone

AbstractBackgroundSubclinical hypothyroidism is a situation in which the thyroid-stimulating hormone (TSH) value exceeds the upper limit of normal, but the free triiodothyronine (T3) and thyroxine (T4) values are within the normal range. The etiology is similar to overt hypothyroidism.Case presentationAn 18-year-old female patient was referred to our endocrinology clinic due to elevated TSH levels detected during a routine examination. She was clinically euthyroid and had a normal thyroid ultrasound pattern. The TSH concentration was measured twice independently, giving values of 5.65 μIU/mL and 5.47 μIU/mL. The polyethylene glycol (PEG) method for TSH measurement was used to determine the concentration of macro-TSH (m-TSH), a macromolecule formed between TSH and immunoglobulin (Ig). Using the same blood samples for which the TSH levels were found to be high, the PEG method found TSH levels to be within a normal range, with values of 1.50 μIU/mL (5.65–1.50 μIU/mL measured; a decrease of 75%) and 1.26 μIU/mL (5.47–1.26 μIU/mL measured; a decrease of 77%), respectively. The TSH values determined by the PEG precipitation test were markedly low, with PEG-precipitable TSH ratios greater than 75%.ConclusionsThe cause of 55% of subclinical hypothyroidism is chronic autoimmune thyroiditis. However, it is necessary to exclude other TSH-elevated conditions for diagnosis. One of these conditions is m-TSH, which should be kept in mind even though it is rarely seen. m-TSH should be considered especially in patients who have a TSH value above 10 μIU/mL without hypothyroidism symptoms or who require a higher levothyroxine replacement dose than expected to make them euthyroid.

Thyroid evaluation of children and adolescents with Williams syndrome in Zhejiang Province

2017 ◽  
Vol 30 (12) ◽  
Author(s):  
Wei-Jun Chen ◽  
Chai Ji ◽  
Dan Yao ◽  
Zheng-Yan Zhao
Keyword(s):  
Children And Adolescents ◽  
Thyroid Function ◽  
Williams Syndrome ◽  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Zhejiang Province ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Thyroid Antibodies ◽  
Free Triiodothyronine

AbstractBackground:The objective of the study was to describe the prevalence of abnormal thyroid function and volume in children and adolescents with Williams syndrome (WS) in Zhejiang Province, China.Methods:Thyroid function, including thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and thyroid antibodies (thyroid peroxidase and thyroglobulin) were measured in 83 patients with WS, aged 0.2–16.5 years. Twenty-three patients were followed for an average of 1.7 years (0.4–4.1), and multiple TSH determinations were considered. Thyroid ultrasonography was performed on 49 patients.Results:One patient was diagnosed with overt hypothyroidism, and 23 patients (27%) had subclinical hypothyroidism (SH). Thyroid antibodies were absent in all patients. In five age groups (0–1 years, 1–3 years, 3–6 years, 6–9 years, 9–18 years), the prevalence of patients with subclinical hypothyroidism was 25%, 28.5%, 44.4%, 16.7% and 4.7%, respectively. Through ultrasound examination, 21 patients (42%) were observed to have thyroid hypoplasia (TH), and there were no cases of thyroid haemiagenesis. The incidence rate of TH increased with age, rising from 20% in the youngest group to 66% in the oldest.Conclusions:SH and TH is common in children and adolescents with WS. Yearly evaluation of thyroid must be performed in all patients in this population, regardless of the result of the neonatal screening. Age under 6 years and existing thyroid abnormalities are risk factors for developing SH, and a shorter follow-up interval is needed for screening in these individuals, SH is often self-limiting, and clinicians should be alert to overt hypothyroidism.

Subclinical hypothyroidism

2019 ◽  
Vol 12 (3) ◽  
pp. 131-135
Author(s):  
Adam Grice
Keyword(s):  
Cardiovascular Disease ◽  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Normal Serum ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Autoimmune Thyroid ◽  
Thyroid Peroxidase Antibodies ◽  
Increased Risk ◽  
Stimulating Hormone

Subclinical hypothyroidism is a common condition associated with a raised thyroid-stimulating hormone and a normal serum free thyroxine that affects about 10% of females over 55 years in age. The most common cause is autoimmune thyroid disease, with 2.5% of patients with subclinical hypothyroidism progressing to clinically overt hypothyroidism each year. The rate of progression is higher in patients with anti-thyroid peroxidase antibodies and higher levels of thyroid-stimulating hormone. Only a small proportion of patients with subclinical hypothyroidism have symptoms, and although there is some debate in the literature about which patients should be treated, the National Institute for Health and Care Excellence clinical knowledge summaries give clear recommendations. There is an increased risk of cardiovascular disease in patients with subclinical hypothyroidism; it is uncertain whether treatment with levothyroxine reduces this risk. When deciding whether to treat subclinical hypothyroidism consider the patient’s age, symptoms, presence of anti-thyroid peroxidase antibodies, thyroid-stimulating hormone levels and risk factors such as cardiovascular disease.

Follow-up of congenital heart disease patients with subclinical hypothyroidism

2014 ◽  
Vol 25 (6) ◽  
pp. 1111-1118
Author(s):  
Efrén Martínez-Quintana ◽  
Fayna Rodríguez-González
Keyword(s):  
Natriuretic Peptide ◽  
Subclinical Hypothyroidism ◽  
Hormone Replacement ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Peroxidase ◽  
C Reactive Protein ◽  
Thyroid Hormone Replacement ◽  
Reactive Protein ◽  
Stimulating Hormone

AbstractIntroduction: Subclinical hypothyroidism or mild thyroid failure is a common problem in patients without known thyroid disease. Methods: Demographic and analytical data were collected in 309, of which 181 were male and 128 were female, congenital heart disease (CHD) patients. CHD patients with thyroid-stimulating hormone above 5.5 mIU/L were also followed up from an analytical point of view to determine changes in serum glucose, cholesterol, N-terminal pro b-type natriuretic peptide, and C-reactive protein concentrations. Results: Of the CHD patients, 35 (11.3%) showed thyroid-stimulating hormone concentration above 5.5 mIU/L. Of them, 27 were followed up during 2.4±1.2 years – 10 were under thyroid hormone replacement treatment, and 17 were not. Of the 27 patients (25.9%), 7 with subclinical hypothyroidism had positive anti-thyroid peroxidase, and 3 of them (42.8%) with positive anti-thyroid peroxidase had Down syndrome. Down syndrome and hypoxaemic CHD patients showed higher thyroid-stimulating hormone concentrations than the rest of the congenital patients (p<0.001). No significant differences were observed in serum thyroxine, creatinine, uric acid, lipids, C-reactive protein, or N-terminal pro b-type natriuretic peptide concentrations before and after the follow-up in those CHD patients with thyroid-stimulating hormone above 5.5 mIU/L whether or not they received levothyroxine therapy. Conclusions: CHD patients with subclinical hypothyroidism showed no significant changes in serum thyroxine, cholesterol, C-reactive protein, or N-terminal pro b-type natriuretic peptide concentrations whether or not they were treated with thyroid hormone replacement therapy.

scholarly journals Subclinical Hypothyroidism and Lipid Metabolism: To Treat or Not to Treat?

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Federica Decandia ◽  
Pierluigi Merella ◽  
Gavino Casu
Keyword(s):  
Lipid Metabolism ◽  
Subclinical Hypothyroidism ◽  
Subclinical Atherosclerosis ◽  
Elevated Serum ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Free Triiodothyronine ◽  
Thyroxine Therapy ◽  
Increased Risk ◽  
Stimulating Hormone

Abstract Thyroid hormones have multiple complex effects on lipid synthesis and metabolism. These physiological actions are well documented in overt hypothyroidism where the elevated levels of total cholesterol, low density lipoporotein cholesterol and possibly triglycerides are reverted by levo-thyroxine therapy. Subclinical hypothyroidism, defined as elevated serum thyroid stimulating hormone in the presence of reference range of free thyroxine and free triiodothyronine concentrations, is a relatively frequent clinical conditions. Many clinical and epidemiological studies have evaluated lipid metabolism, markers of subclinical atherosclerosis and other cardiovascular risk factors in subclinical hypothyroidism as well as the need of replacement therapy in these patients. The available results are rather conflicting, with variable and inconclusive results. Moreover, no consensus still exists on the clinical significance and treatment of this mild form of thyroid failure. On the contrary, available evidences suggest that patients with plasma thyroid stimulating hormone levels above 10 mU/L should be treated with levo-thyroxine, since may have an increased risk of cardiovascular disease. However, the epidemiological evidences suggest being rather conservative in older people, since higher thyroid stimulating hormone is associated with lower risk of multiple adverse events in this population. In this review, we summarized the current evidences on the association between subclinical hypothyroidism and lipid metabolism and the effect of levo-thyroxine therapy on lipid parameters.

scholarly journals Evaluation of renal function in subclinical hypothyroidism

2018 ◽  
Vol 10 (01) ◽  
pp. 050-055 ◽  
Author(s):  
Vijayetha P. Patil ◽  
Alagilwada S. Shilpasree ◽  
Vidya S. Patil ◽  
Kangokar R. Pravinchandra ◽  
Deepti G. Ingleshwar ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Subclinical Hypothyroidism ◽  
Linear Regression Analysis ◽  
Laboratory Diagnosis ◽  
Thyroid Stimulating Hormone ◽  
Function Parameter ◽  
Overt Hypothyroidism ◽  
Free Triiodothyronine ◽  
Cross Sectional

Abstract INTRODUCTION: Patients with subclinical hypothyroidism (SCH) have a few or no symptoms or signs of thyroid dysfunction and thus by its very nature, SCH is a laboratory diagnosis. Serum creatinine is elevated and glomerular filtration rate (GFR) values are reversibly reduced in overt hypothyroid patients. We hypothesize that SCH also may be associated with low GFR. AIMS AND OBJECTIVES: The objective of this study was (1) to know the effect of SCH on kidney function, (2) to find the correlation between the renal function parameter creatinine, estimated GFR (eGFR), and thyroid-stimulating hormone (TSH), and (3) to know if creatinine values can be predicted by TSH values in SCH cases. MATERIALS AND METHODS: This is a hospital-based cross-sectional study for 1 year. A total of 608 subjects of either sex were included in the study and were divided into 3 groups: (1) SCH, (2) overt hypothyroidism (OHT), and (3) euthyroidism (ET). TSH, free triiodothyronine, free thyroxine, and serum creatinine were estimated and eGFR was calculated using modification of diet in renal disease study equation and the chronic kidney disease epidemiology collaboration equations. RESULTS: Serum creatinine levels were higher and eGFR was lower significantly in the subclinical hypothyroid group when compared to the control ET group (P < 0.001). The overtly hypothyroid group had significantly higher levels of serum creatinine and lower eGFR when compared to both the groups (P < 0.001). Significant correlation between TSH, creatinine, and eGFR was found in OHT group only. Linear regression analysis showed the regression in creatinine upon TSH is attributable to 44.5% among OHT group, 48.2% in SCH group. CONCLUSION: It can be concluded that the SCH group behaves biochemically similar to OHT group and changes in serum creatinine reflect tissue hypothyroidism in SCH cases.

scholarly journals Variation in thyroid function in subclinical hypothyroidism: importance of clinical follow-up and therapy

2011 ◽  
Vol 164 (3) ◽  
pp. 317-323 ◽  
Author(s):  
Jesper Karmisholt ◽  
Stig Andersen ◽  
Peter Laurberg
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Repeated Measurements ◽  
Thyroid Peroxidase ◽  
Biochemical Tests ◽  
Free Triiodothyronine ◽  
Significant Difference ◽  
Hypothyroid Patients ◽  
Symptoms And Signs

Subclinical hypothyroidism (SCH) is a common condition that is often observed without therapy. However, no evidence-based recommendation exists with regards to how patients with untreated SCH should be monitored.Monitoring involves regular assessment of symptoms and signs of hypothyroidism (HYPO) and biochemical tests of thyroid function. An important question when repeated tests of thyroid function are performed is how large a difference in test results is needed to be confident that the change is real and not just due to chance variation.Recent data show that the least significant difference between two tests in SCH is 40% for TSH and 15% for free thyroxine and free triiodothyronine, with 90% confidence. Furthermore, monitoring has to be based on biochemical function testing because serial evaluation of symptoms and signs related to HYPO is rather insensitive in detecting worsening of thyroid insufficiency.When the presence of thyroid peroxidase auto-antibodies (TPO-Ab) in serum has been demonstrated, repeated measurements do not add much useful information in the monitoring of individual subclinical hypothyroid patients, as levels of TPO-Ab vary in parallel with TSH in these patients.Lastly, we discuss how differences in the monitoring procedure influence the diagnostic outcome, and we suggest a follow-up approach for untreated subclinical hypothyroid patients.

scholarly journals Management of Subclinical Hypothyroidism

2014 ◽  
Vol 13 (3) ◽  
pp. 93-96
Author(s):  
Shaheda Ahmed ◽  
A S M Towhidul Alam
Keyword(s):  
Clinical Features ◽  
Subclinical Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Serum Thyroxine ◽  
Specific Symptoms ◽  
Review Current ◽  
Serum Tsh ◽  
Low Serum ◽  
Stimulating Hormone

Objective: To review current concepts in the management of subclinical hypothyroidism (SCH) in patients with non-specific symptoms.Data sources: A review of articles reported on overt hypothyroidism and subclinical hypothyroidism. Summary of review: In a patient with primary overt hypothyroidism, management is usually straightforward: treatment with thyroxine should be offered to anyone with characteristic clinical features, a raised serum thyroid stimulating hormone (TSH) concentration and a low serum thyroxine (T4) concentration. More difficult is the management of a patient with subclinical hypothyroidism (SCH), in whom serum TSH is slightly raised (5-20 mIU/L) but T3, T4 levels are normal, and who is either asymptomatic or has only non-specific symptoms. Left untreated, some of these patients will eventually develop overt hypothyroidism. This review will address the use of thyroxine in patients with subclinical hypothyroidism.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i3.21045 

scholarly journals A clinico-epidemiological analysis of subclinical hypothyroidism in a tertiary care health center

2019 ◽  
Vol 6 (4) ◽  
pp. 1079
Author(s):  
Vaibhav Agrawal ◽  
Virendra Patil ◽  
Ashok Kshirsagar
Keyword(s):  
Subclinical Hypothyroidism ◽  
Clinical Symptoms ◽  
Tertiary Care ◽  
Thyroid Stimulating Hormone ◽  
Common Symptom ◽  
Age Group ◽  
Free Triiodothyronine ◽  
High Prevalence ◽  
Care Health ◽  
Serum Tsh

Background: Subclinical hypothyroidism (SCH) is defined by increase in serum thyroid stimulating hormone (TSH) and free thyroxine (FT4) and free triiodothyronine (FT3) levels within normal range, coupled with absence of typical clinical symptoms. The present study was undertaken to analyse the SCH associated comorbidities, especially lipid disturbances, thyroid autoantibodies, etc.Methods: The present study was retrospective observational study, which was carried out at a tertiary health care center.Results: Out of the 100 patients, majority were in the age group 21 to 30 years (31 patients), followed by 26 patients in age group >51 years and least in age group 41 to 50 years. Prevalence showed female predilection, with female: male ratio of 1.9:1. Most common symptom reported was general fatigue, which was encountered in 40 patients, followed by weight gain, menstrual abnormalities, and constipation. 10 patients were asymptomatic. Serum TSH range in the patients was 5 to 21.1 µIU/l, while mean TSH was 10.9 µIU/l. 20 patients were found to have serum TSH>10.Conclusions: Despite high prevalence, detection rate of subclinical hypothyroidism is very low. Carrying out epidemiological study on national scale is need of the hour, as lack of typical clinical features makes the detection less likely and it has numerous complications, if untreated.

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