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 

Pattern of dyslipidemia among patients with subclinical hypothyroidism and its relation with thyroid stimulating hormone

2021 ◽  
Vol 11 (3) ◽  
pp. 172-178
Author(s):  
Nazma Akter ◽  
Tangera Akter
Keyword(s):  
Lipid Profile ◽  
Subclinical Hypothyroidism ◽  
Lipid Level ◽  
Density Lipoprotein ◽  
Thyroid Stimulating Hormone ◽  
Lipoprotein Cholesterol ◽  
Control Group ◽  
Thyroid Disorder ◽  
Serum Tsh ◽  
Stimulating Hormone

Background: The relationship between subclinical hypothyroidism (SCH) and dyslipidemia is still debatable about whether SCH is constantly associated with lipid disorder. The aim of this study was to assess the lipid abnormalities in patients with SCH and to evaluate the relation between thyroid stimulating hormone (TSH) and lipid profile. Methods: This cross-sectional observational study was conducted in outpatient department (OPD) of the Hormone and Diabetes Clinic at MARKS Medical College & Hospital in Dhaka, Bangladesh from May 2018 to October 2019. A total of 308 subjects (age 30 - 60 years) were included in this study using covenience sampling. Among them, 156 were diagnosed case of SCH, while 152 were euthyroid healthy individuals in control group (matched for age, gender and weight). Laboratory test included serum TSH and free thyroxine (FT4) and fasting lipid profile. Data were analyzed using SPSS version 18 statistical software. Results: In this study, dyslipidemia was more prevalent in patients with SCH compared to control group [p<0.001]. SCH group showed altered lipid profile i.e. significantly higher serum total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglycerides (TGs) and lower high density lipoprotein cholesterol (HDL-C) when compared with the euthyroid subjects [p < 0.05 for each]. Pearson’s correlation coefficient for the relationships between serum TSH and lipid level showed that TSH levels were positively correlated with TC, LDL-C, TG and negatively correlated with HDL-C in patients with SCH [p < 0.05 for each]. Conclusions: Dyslipidemia is a common feature in SCH compared to euthyroid controls. The study showed that TSH level was positively correlated with TC, LDL-C, TG and negatively correlated with HDL-C. SCH should be a matter for further investigation because dyslipidemia is associated with this thyroid disorder. BIRDEM Med J 2021; 11(3): 172-178

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.

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.

Hypothyroidism With Thyroxine-Binding Gobulin Excess

PEDIATRICS ◽  
1989 ◽  
Vol 84 (1) ◽  
pp. 197-197
Author(s):  
ALEXANDER K. C. LEUNG ◽  
ROBERT G. MCARTHUR
Keyword(s):  
Clinical Features ◽  
Recent Article ◽  
Bone Age ◽  
Thyroid Stimulating Hormone ◽  
Growth Delay ◽  
Normal Range ◽  
Thyroxine Binding Globulin ◽  
Serum Thyroxine ◽  
Developmental And Growth Delay ◽  
Stimulating Hormone

Since our letter was printed in January 1989, we have come across an additional example of thyroxine-binding globulin (TBG) excess associated with hypothyroidism. In a recent article, Menon reported the case of a 21-month-old boy with developmental and growth delay and other clinical features of hypothyroidism. Investigations confirmed the diagnosis of hypothyroidism: serum thyroxine (T4) 28 nmol/L (normal range 60 to 140 nmol/L), thyroid-stimulating hormone (TSH) 100 mU/L (normal range 2 to 10 mU/L), and bone age 4 months.

Subclinical hypothyroidism: an audit of management

2003 ◽  
Vol 40 (6) ◽  
pp. 694-696
Author(s):  
PK Prakash ◽  
H Bolusani ◽  
A Hameed ◽  
LDKE Premawardhana
Keyword(s):  
Subclinical Hypothyroidism ◽  
Thyroid Disease ◽  
Treatment Guidelines ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Thyroid Peroxidase ◽  
Amiodarone Therapy ◽  
Retrospective Case ◽  
General Physicians ◽  
Serum Tsh

Background: Subclinical hypothyroidism (SH) is a marker for overt hypothyroidism and vascular disease. Treatment guidelines are not universally followed. Thyroxine is recommended if serum thyroid-stimulating hormone (TSH) concentration is 10 mU/L or more, or if serum TSH is 5-9.9 mU/L (mild SH) with other risk factors, such as thyroid peroxidase antibodies (TPOAb). Methods: We examined the management of mild SH in a retrospective case note audit of 150 consecutive subjects. Twenty-seven subjects with a serum TSH concentration above 10 mU/L were excluded from analysis. Of the group with mild SH, 27 were also excluded because of previous thyroid disease or amiodarone therapy. Results: The prevalence of previous thyroid disease was similar in subjects with TSH 10 mU/L or more, compared to those with mild SH. Overall, both TPOAb and goitre status were determined in only 39% of subjects with mild SH, but in more by endocrinologists compared with general physicians (63% versus 22% for TPOAb; 47% versus 17% for goitre) ( P = 0.001). Endocrinologists treated a greater number of subjects with mild SH who were eligible for thyroxine therapy compared to nonendocrine colleagues (96% versus 67%) ( P = 0.024). Both groups treated subjects in whom TPOAb status was not determined (endocrinologists 21% versus general physicians 40%) ( P = 0.21). Conclusion: In subjects with mild SH, evaluation is incomplete, a large percentage who were TPOAb positive were on appropriate therapy, thyroxine was prescribed when TPOAb status was unknown and, on the whole, endocrinologists performed better than general physicians.

Symptomatic Subclinical Hypothyroidism Treated with Homoeopathy: Case Reports

2020 ◽  
Vol 33 (02) ◽  
pp. 120-125
Author(s):  
Pulakendu Bhattacharya ◽  
Shashi Giri ◽  
Baishakhi Ghosh ◽  
Abhiram Banerjee
Keyword(s):  
Cardiovascular Diseases ◽  
Normal Level ◽  
Subclinical Hypothyroidism ◽  
Case Reports ◽  
Age Groups ◽  
Thyroid Stimulating Hormone ◽  
Older Age ◽  
Overt Hypothyroidism ◽  
Tsh Levels ◽  
Stimulating Hormone

AbstractSubclinical hypothyroidism (SCH) is a condition where serum thyroid-stimulating hormone (TSH) level is high, but the T3 and T4 are within normal level. SCH carries a risk of cardiovascular diseases or progression to overt hypothyroidism. Treatment becomes more necessary in case of older age groups and in females. Two cases of SCH treated with individualised homoeopathic medicine are presented and the improvement was significant showing reduction in the TSH levels with overall improvement in health.

Prevalence of iatrogenic hypothyroidism in hyperthyroid cats treated with radioiodine using an individualised scoring system

2019 ◽  
Vol 21 (12) ◽  
pp. 1149-1156
Author(s):  
Yordan Fernandez ◽  
Jordi Puig ◽  
Roger Powell ◽  
Mayank Seth
Keyword(s):  
Scoring System ◽  
Scoring Systems ◽  
Thyroid Stimulating Hormone ◽  
Overt Hypothyroidism ◽  
Predictive Values ◽  
System A ◽  
Serum T4 ◽  
Total Thyroxine ◽  
Serum Tsh ◽  
Low Serum

Objectives The aim of this study was to report the prevalence of iatrogenic hypothyroidism, with or without azotaemia, based on the measurement of serum total thyroxine (T4), thyroid-stimulating hormone (TSH) and creatinine concentrations, in hyperthyroid cats undergoing radioiodine (131I) treatment where the 131I dose was calculated using a previously described scoring system. A secondary aim of the study was to determine the positive and negative predictive values of serum T4 and TSH concentrations obtained 19 days after treatment in order to predict the development of iatrogenic hypothyroidism 6–9 months after 131I treatment. Methods Serum T4, TSH and creatinine concentrations were measured 19 days and 6–9 months after 131I treatment. The prevalence of iatrogenic hypothyroidism was assessed with the results obtained 6–9 months after 131I treatment. Results The prevalence of overt and subclinical hypothyroidism 6–9 months after 131I treatment was 40.0% (22/55 cats) and 12.7% (7/55 cats). Overt hypothyroidism with azotaemia was diagnosed in 8/55 (14.5%) cats. The positive and negative predictive values for the prediction of the development of iatrogenic hypothyroidism 6–9 months after 131I treatment were 72.2% and 80.0%, respectively, for a low serum T4 concentration, and 75.0% and 44.6%, respectively, for an increased serum TSH concentration. Conclusions and relevance The use of an individualised scoring system is effective in determining the 131I dose for the treatment of hyperthyroid cats. However, the prevalence of overt hypothyroidism was higher in comparison with other studies using different dosing protocols. Further studies comparing the efficacy of individualised scoring systems and different fixed doses to determine which method is superior are warranted.

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.

scholarly journals Association of Thyroid Stimulating Hormone with Insulin Resistance in Women with Polycystic Ovarian Syndrome

2016 ◽  
Vol 11 (1) ◽  
pp. 69-73
Author(s):  
Salma Naher ◽  
Sultana Rajia Begum ◽  
Liaquat Ali ◽  
Maksumul Hakim
Keyword(s):  
Insulin Resistance ◽  
Insulin Sensitivity ◽  
Subclinical Hypothyroidism ◽  
Polycystic Ovarian Syndrome ◽  
Thyroid Stimulating Hormone ◽  
Model Assessment ◽  
C Peptide ◽  
Ovarian Syndrome ◽  
Serum Tsh ◽  
Stimulating Hormone

Introduction: Polycystic Ovarian Syndrome (PCOS) is a major cause of female infertility which is thought to be associated with Insulin Resistance (IR). However the nature and degree of IR have been shown to vary in different populations. PCOS women have also been reported to have increased prevalence of subclinical hypothyroidism which has been postulated to be determinants of IR. The natures of thyroid involvement have also been shown to vary between populations.Objectives: The study was undertaken to explore the distribution of IR and thyroid dysfunction as assessed by Thyroid Stimulating Hormone (TSH) levels among PCOS subjects and also to investigate the association of IR with TSH in women with PCOS.Materials and Methods: One hundred and fifty one PCOS patients (age in years 24±5; M±SD) were studied. PCOS was diagnosed by Rotterdam criteria. Fasting serum C-peptide was measured by Enzyme Linked Immuno Sorbide Essay (ELISA) and serum TSH was measured by Microparticle Enzyme Immunoassay (MEIA). Serum glucose was estimated by Glucose-Oxidase method (GOD-PAP). Insulin sensitivity was assessed by using Homeostasis Model Assessment (HOMA).Results: The mean serum C-peptide (nmol/l) and HOMA%S were 0.67 (±0.35) and 85 (±42) respectively. The median (Range) serum TSH level (?lU/ml) of the study subjects was found to be 2.49 (0.66 to 20.86). Insulin sensitivity was found to be 26%, 47%, 17% and 10% in those who had HOMA%S level at the range of <50, 50-100, 101-150 and >150 respectively. Of the total PCOS subjects, 85% had normal level of TSH value whereas only 15% PCOS subjects had subclinical hypothyroidism. The median serum TSH level of the insulin resistance and non-resistance groups were 2.25 (0.89-5.71) and 2.58 (0.74-20.86) respectively. On Pearson's correlation analysis insulin sensitivity was not found to be any significant association with TSH in the PCOS subjects.Conclusion: The study revealed that there was no significant association with IR and TSH in the PCOS subjects.Journal of Armed Forces Medical College Bangladesh Vol.11(1) 2015: 69-73

scholarly journals Subclinical Hypothyroidism: A Review on Clinical Consequences and Management Strategies

2017 ◽  
Vol 18 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Nazma Akter ◽  
Nazmul Kabir Qureshi ◽  
Hossain Shahid Ferdous
Keyword(s):  
Subclinical Hypothyroidism ◽  
Management Strategies ◽  
Elevated Serum ◽  
Thyroid Stimulating Hormone ◽  
Current Evidence ◽  
Clinical Aspects ◽  
Overt Hypothyroidism ◽  
Cardiac Events ◽  
Clinical Consequences ◽  
Serum Tsh

Subclinical hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone (TSH) level with normal free thyroid hormone values. The prevalence of subclinical hypothyroidism is 3 to 8 percent in the general population, and up to 15 to 18 percent in women who are older than 60 years. It is more common in women than men, and its prevalence increases with age. Of patients with SCH, 80% have a serum TSH of less than 10 mIU/L. Management strategies including screening and treatment of subclinical hypothyroidism are still controversial. The strongest arguments for levothyroxine therapy are the high risk of progression to overt hypothyroidism. Initiating levothyroxine replacement therapy is recommended for all patients with a TSH greater than 10 mIU/L, even if the free thyroxine concentration is within normal laboratory range. However, treatment of patients with a serum TSH level between 5 and 10 mIU/L remains controversial. There was insufficient evidence for a clinically significant relationship between subclinical hypothyroidism and adverse cardiac events or cardiac dysfunction. Conflicting results have been found on the association between subclinical hypothyroidism and cognitive impairment, depression and the risk of fractures. This narrative review aims to assess current evidence on the clinical aspects, as well as screening and treatment recommendations in adults with subclinical hypothyroidism.J MEDICINE January 2017; 18 (1) : 30-36

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