Subclinical hypothyroidism: Difference between revisions
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In [[medicine]], '''subclinical hypothyroidism''' is an elevated [[thyrotropin]] (TSH) concentration can maintain a normal or near normal [[thyroxine ]](T4) concentration. | In [[medicine]], '''subclinical hypothyroidism''' is an elevated [[thyrotropin]] (TSH) concentration can maintain a normal or near normal [[thyroxine ]](T4) concentration.<ref name="pmid14722150">{{cite journal| author=Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH et al.| title=Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. | journal=JAMA | year= 2004 | volume= 291 | issue= 2 | pages= 228-38 | pmid=14722150 | doi=10.1001/jama.291.2.228 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14722150 }} </ref><ref name="pmid22273398">{{cite journal| author=Cooper DS, Biondi B| title=Subclinical thyroid disease. | journal=Lancet | year= 2012 | volume= 379 | issue= 9821 | pages= 1142-54 | pmid=22273398 | doi=10.1016/S0140-6736(11)60276-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22273398 }} </ref> | ||
==Prognosis== | ==Prognosis== | ||
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The thyrotropin level helps predict progression to overt hypothyroidism.<ref name="pmid17646608">{{cite journal| author=Meyerovitch J, Rotman-Pikielny P, Sherf M, Battat E, Levy Y, Surks MI| title=Serum thyrotropin measurements in the community: five-year follow-up in a large network of primary care physicians. | journal=Arch Intern Med | year= 2007 | volume= 167 | issue= 14 | pages= 1533-8 | pmid=17646608 | doi=10.1001/archinte.167.14.1533 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17646608 }} </ref> | The thyrotropin level helps predict progression to overt [[hypothyroidism]].<ref name="pmid17646608">{{cite journal| author=Meyerovitch J, Rotman-Pikielny P, Sherf M, Battat E, Levy Y, Surks MI| title=Serum thyrotropin measurements in the community: five-year follow-up in a large network of primary care physicians. | journal=Arch Intern Med | year= 2007 | volume= 167 | issue= 14 | pages= 1533-8 | pmid=17646608 | doi=10.1001/archinte.167.14.1533 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17646608 }} </ref> | ||
===Antithyroid peroxidase antibodies=== | ===Antithyroid peroxidase antibodies=== | ||
| Line 23: | Line 23: | ||
Diagnostic accuracy for predicting over [[hypothyroidism]] has been reported. | Diagnostic accuracy for predicting over [[hypothyroidism]] has been reported. | ||
Diez et al found that antibodies were significant predictors, but ''not'' after controlling for initial | Diez et al found that antibodies were significant predictors, but ''not'' after controlling for initial [[thyrotropin]] level. <ref name="pmid15472181">{{cite journal| author=Díez JJ, Iglesias P| title=Spontaneous subclinical hypothyroidism in patients older than 55 years: an analysis of natural course and risk factors for the development of overt thyroid failure. | journal=J Clin Endocrinol Metab | year= 2004 | volume= 89 | issue= 10 | pages= 4890-7 | pmid=15472181 | doi=10.1210/jc.2003-032061 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15472181 }} </ref> | ||
* Sensitivity 93% | * Sensitivity 93% | ||
* Specificity 30% | * Specificity 30% | ||
Revision as of 08:45, 19 April 2012
In medicine, subclinical hypothyroidism is an elevated thyrotropin (TSH) concentration can maintain a normal or near normal thyroxine (T4) concentration.[1][2]
Prognosis
Thyrotropin level
| Follow-up TSH value | ||
|---|---|---|
| TSH > 10 | TSH < 10 | |
| TSH > 10 | 35% | 64% |
| TSH 5.5 - 10 | 3% | 97% |
The thyrotropin level helps predict progression to overt hypothyroidism.[3]
Antithyroid peroxidase antibodies
Antithyroid peroxidase (also called antithyroid microsomal) antibodies my help predict progression to overt hypothyroidism.[4]
Diagnostic accuracy for predicting over hypothyroidism has been reported.
Diez et al found that antibodies were significant predictors, but not after controlling for initial thyrotropin level. [4]
- Sensitivity 93%
- Specificity 30%
Screening
The US Preventive Services Task Force states:[5]
- "t is uncertain whether treatment will improve quality of life in otherwise healthy patients who have abnormal TSH levels and normal free thyroxine levels"
References
- ↑ Surks MI, Ortiz E, Daniels GH, Sawin CT, Col NF, Cobin RH et al. (2004). "Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.". JAMA 291 (2): 228-38. DOI:10.1001/jama.291.2.228. PMID 14722150. Research Blogging.
- ↑ Cooper DS, Biondi B (2012). "Subclinical thyroid disease.". Lancet 379 (9821): 1142-54. DOI:10.1016/S0140-6736(11)60276-6. PMID 22273398. Research Blogging.
- ↑ 3.0 3.1 Meyerovitch J, Rotman-Pikielny P, Sherf M, Battat E, Levy Y, Surks MI (2007). "Serum thyrotropin measurements in the community: five-year follow-up in a large network of primary care physicians.". Arch Intern Med 167 (14): 1533-8. DOI:10.1001/archinte.167.14.1533. PMID 17646608. Research Blogging.
Cite error: Invalid
<ref>tag; name "pmid17646608" defined multiple times with different content - ↑ 4.0 4.1 Díez JJ, Iglesias P (2004). "Spontaneous subclinical hypothyroidism in patients older than 55 years: an analysis of natural course and risk factors for the development of overt thyroid failure.". J Clin Endocrinol Metab 89 (10): 4890-7. DOI:10.1210/jc.2003-032061. PMID 15472181. Research Blogging.
Cite error: Invalid
<ref>tag; name "pmid15472181" defined multiple times with different content - ↑ Helfand M, U.S. Preventive Services Task Force (2004). "Screening for subclinical thyroid dysfunction in nonpregnant adults: a summary of the evidence for the U.S. Preventive Services Task Force.". Ann Intern Med 140 (2): 128-41. PMID 14734337. [e]