Subclinical thyroid disorders: Significance and clinical impact

Journal of Clinical Pathology

Volumn 63, Issue 5, 2010, Pages 379-386

  Razvi, Salman ^a,b   Weaver, Jolanta U ^a,c   Pearce, Simon H S ^b,d  

^a GATESHEAD HEALTH NHS FOUNDATION TRUST   (United Kingdom)

^b NEWCASTLE UNIVERSITY   (United Kingdom)

^c NEWCASTLE UNIVERSITY   (United Kingdom)

^d ROYAL VICTORIA INFIRMARY   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

AMIODARONE; ANTICONVULSIVE AGENT; GLUCOCORTICOID; INTERFERON; LEVODOPA; LEVOTHYROXINE; LIOTHYRONINE; LITHIUM; OPIATE; SUNITINIB; THIAMAZOLE; THYROID EXTRACT; THYROTROPIN;

BONE MASS; CARDIOVASCULAR RISK; CLINICAL TRIAL; DEMENTIA; DISEASE COURSE; FRACTURE; HUMAN; HYPERTHYROIDISM; HYPOTHYROIDISM; MORTALITY; MUSCLE FUNCTION; PREGNANCY; PREVALENCE; PRIORITY JOURNAL; REVIEW; THYROID FUNCTION TEST; THYROTROPIN BLOOD LEVEL; TREATMENT OUTCOME;

HUMANS; HYPERTHYROIDISM; HYPOTHYROIDISM; REFERENCE VALUES; THYROTROPIN; THYROXINE; TREATMENT OUTCOME;

EID: 77951657379     PISSN: 00219746     EISSN: 14724146     Source Type: Journal    
DOI: 10.1136/jcp.2008.057414     Document Type: Review

References (93)

1. Allahabadia A, Razvi S, Abraham P, et al. Diagnosis and treatment of primary hypothyroidism. BMJ 2009;338:b725.
2. Romijn JA, Adriaanse R, Brabant G, et al. Pulsatile secretion of thyrotropin during fasting: a decrease of thyrotropin pulse amplitude. J Clin Endocrinol Metab 1990;70:1631-1636 (Pubitemid 20192915)
3. Brabant G, Prank K, Ranft U, et al. Physiological regulation of circadian and pulsatile thyrotropin secretion in normal man and woman. J Clin Endocrinol Metab 1990;70:403-409
4. Romijn JA, Wiersinga WM. Decreased nocturnal surge of thyrotropin in nonthyroidal illness. J Clin Endocrinol Metab 1990;70:35-42. (Pubitemid 20045922)
5. Baloch Z, Carayon P, Conte-Devolx B, et al; 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.
6. Pedersen OM, Aardal NP, Larssen TB, et al. The value of ultrasonography in predicting autoimmune thyroid disease. Thyroid 2000;10:251-259 (Pubitemid 30202412)
7. Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004;291:228-238
8. Spencer CA, Hollowell JG, Kazarosyan M, et al. National Health and Nutrition Examination Survey III thyroid-stimulating hormone (TSH)-thyroperoxidase antibody relationships demonstrate that TSH upper reference limits may be skewed by occult thyroid dysfunction. J Clin Endocrinol Metab 2007;92:4236-4240 (Pubitemid 350074737)
9. Hollowell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002;87:489-499
10. Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995;43:55-68.
11. Tunbridge WM, Evered DC, Hall R, et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol 1977;7:481-493 (Pubitemid 8235965)
12. Wartofsky L, Dickey RA. The evidence for a narrower thyrotropin reference range is compelling. J Clin Endocrinol Metab 2005;90:5483-5488 (Pubitemid 41262320)
13. American Association of Clinical Endocrinologists. Subclinical thyroid disease. http://www.aace.com/pub/positionstatements/subclinical.php (accessed 2 Oct 2009).
14. Surks MI, Goswami G, Daniels GH. The thyrotropin reference range should remain unchanged. J Clin Endocrinol Metab 2005;90:5489-5496 (Pubitemid 41262321)
15. Beckett G, Mackenzie F. Thyroid guidelines - are thyroid-stimulating hormone assays fit for purpose? Ann Clin Biochem 2007;44:203-208
16. Meyerovitch J, Rotman-Pikielny P, Sherf M, et al. Serum thyrotropin measurements in the community: five-year follow-up in a large network of primary care physicians. Arch Intern Med 2007;167:1533-1538 (Pubitemid 47124184)
17. Canaris GJ, Manowitz NR, Mayor G, et al. The Colorado thyroid disease prevalence study. Arch Intern Med 2000;160:526-534 (Pubitemid 30112276)
18. Surks MI, Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. J Clin Endocrinol Metab 2007;92:4575-4582
19. Rosenthal MJ, Hunt WC, Garry PJ, et al. Thyroid failure in the elderly. Microsomal antibodies as discriminant for therapy. JAMA 1987;258:209-213
20. Huber G, Staub JJ, Meier C, et al. Prospective study of the spontaneous course of subclinical hypothyroidism: prognostic value of thyrotropin, thyroid reserve, and thyroid antibodies. J Clin Endocrinol Metab 2002;87:3221-3226 (Pubitemid 34816369)
21. Diez JJ, Iglesias P. 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 2004;89:4890-4897 (Pubitemid 39391424)
22. Karmisholt J, Andersen S, Laurberg P. Interval between tests and thyroxine estimation method influence outcome of monitoring of subclinical hypothyroidism. J Clin Endocrinol Metab 2008;93:1634-1640 (Pubitemid 351656498)
23. Parle JV, Franklyn JA, Cross KW, et al. Assessment of a screening process to detect patients aged 60 years and over at high risk of hypothyroidism. Br J Gen Pract 1991;41:414-416
24. Cooper DS, Halpern R, Wood LC, et al. L-Thyroxine therapy in subclinical hypothyroidism. A double-blind, placebo-controlled trial. Ann Intern Med 1984;101:18-24.
25. Zulewski H, Müller B, Exer P, et al. Estimation of tissue hypothyroidism by a new clinical score: evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab 1997;82:771-776 (Pubitemid 27106585)
26. Razvi S, Ingoe LE, McMillan CV, et al. Health status in patients with sub-clinical hypothyroidism. Eur J Endocrinol 2005;152:713-717 (Pubitemid 40744539)
27. Monzani F, Del Guerra P, Caraccio N, et al. Subclinical hypothyroidism: neurobehavioral features and beneficial effect of L-thyroxine treatment. Clin Investig 1993;71:367-371 (Pubitemid 23142835)
28. Baldini IM, Vita A, Mauri MC, et al. Psychopathological and cognitive features in subclinical hypothyroidism. Prog Neuropsychopharmacol Biol Psychiatry 1997;21:925-935 (Pubitemid 27410385)
29. Ganguli M, Burmeister LA, Seaberg EC, et al. Association between dementia and elevated TSH: a community-based study. Biol Psychiatry 1996;40:714-725 (Pubitemid 26353964)
30. Monzani F, Caraccio N, Siciliano G, et al. Clinical and biochemical features of muscle dysfunction in subclinical hypothyroidism. J Clin Endocrinol Metab 1997;82:3315-3318 (Pubitemid 27419078)
31. Staub JJ, Althaus BU, Engler H, et al. Spectrum of subclinical and overt hypothyroidism: effect on thyrotropin, prolactin, and thyroid reserve, and metabolic impact on peripheral target tissues. Am J Med 1992;92:631-642
32. Lindeman RD, Schade DS, LaRue A, et al. Subclinical hypothyroidism in a biethnic, urban community. J Am Geriatr Soc 1999;47:703-709 (Pubitemid 29266638)
33. Manciet G, Dartigues JF, Decamps A, et al. The PAQUID survey and correlates of subclinical hypothyroidism in elderly community residents in the southwest of France. Age Ageing 1995;24:235-241
34. Luboshitzky R, Oberman AS, Kaufman N, et al. Prevalence of cognitive dysfunction and hypothyroidism in an elderly community population. Isr J Med Sci 1996;32:60-65 (Pubitemid 26034814)
35. Jorde R, Waterloo K, Storhaug H, et al. Neuropsychological function and symptoms in subjects with subclinical hypothyroidism and the effect of thyroxine treatment. J Clin Endocrinol Metab 2006;91:145-153 (Pubitemid 43069130)
36. Dean JW, Fowler PB. Exaggerated responsiveness to thyrotrophin releasing hormone: a risk factor in women with coronary artery disease. Br Med J (Clin Res Ed) 1985;290:1555-1561
37. Hak AE, Pols HA, Visser TJ, et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 2000;132:270-278
38. Tunbridge WM, Evered DC, Hall R, et al. Lipid profiles and cardiovascular disease in the Whickham area with particular reference to thyroid failure. Clin Endocrinol (Oxf) 1977;7:495-508. (Pubitemid 8235966)
39. Imaizumi M, Akahoshi M, Ichimaru S, et al. Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism. J Clin Endocrinol Metab 2004;89:3365-3370
40. Lindeman RD, Romero LJ, Schade DS, et al. Impact of subclinical hypothyroidism on serum total homocysteine concentrations, the prevalence of coronary heart disease (CHD), and CHD risk factors in the New Mexico Elder Health Survey. Thyroid 2003;13:595-600.
41. Rodondi N, Newman AB, Vittinghoff E, et al. Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med 2005;165:2460-2466 (Pubitemid 41720006)
42. Walsh JP, Bremner AP, Bulsara MK, et al. Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med 2005;165:2467-2472 (Pubitemid 41720007)
43. Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA 2006;295:1033-1041 (Pubitemid 43313719)
44. Vanderpump MP, Tunbridge WM, French JM, et al. The development of ischemic heart disease in relation to autoimmune thyroid disease in a 20-year follow-up study of an English community. Thyroid 1996;6:155-160
45. Parle JV, Maisonneuve P, Sheppard MC, et al. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet 2001;358:861-865 (Pubitemid 32900566)
46. Gussekloo J, van Exel E, de Craen AJ, et al. Thyroid status, disability and cognitive function, and survival in old age. JAMA 2004;292:2591-2599 (Pubitemid 39577515)
47. Razvi S, Shakoor A, Weaver JU, et al. The influence of age on ischeamic heart disease and mortality in subclinical hypothyroidism - a meta-analysis. J Clin Endocrinol Metab 2008;93:2998-3007.
48. Klein RZ, Haddow JE, Faix JD, et al. Prevalence of thyroid deficiency in pregnant women. Clin Endocrinol (Oxf) 1991;35:41-46
49. Casey BM, Leveno KJ. Thyroid disease in pregnancy. Obstet Gynecol 2006;108:1283-1292
50. Smallridge RC, Glinoer D, Hollowell JG, et al. Thyroid function inside and outside of pregnancy: what do we know and what don't we know? Thyroid 2005;15:54-59
51. Leung AS, Millar LK, Koonings PP, et al. Perinatal outcome in hypothyroid pregnancies. Obstet Gynecol 1993;81:349-353
52. Haddow JE, Palomaki GE, Allan WC, et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999;341:549-555
53. Pop VJ, Kuijpens JL, van Baar AL, et al. Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy. Clin Endocrinol (Oxf) 1999;50:149-155
54. Vaidya B, Anthony S, Bilous M, et al. Detection of thyroid dysfunction in early pregnancy: universal screening or targeted high-risk case finding? J Clin Endocrinol Metab 2007;92:203-207
55. Nystrom E, Caidahl K, Fager G, et al. A double-blind cross-over 12-month study of L-thyroxine treatment of women with 'subclinical' hypothyroidism. Clin Endocrinol (Oxf) 1988;29:63-67
56. Razvi S, Ingoe L, Keeka G, et al. The beneficial effect of L-thyroxine on cardiovascular risk factors, endothelial function and quality of life in subclinical hypothyroidism: randomized, crossover trial. J Clin Endocrinol Metab 2007;92:1715-1723 (Pubitemid 46997177)
57. Jaeschke R, Guyatt G, Gerstein H, et al. Does treatment with L-thyroxine influence health status in middle-aged and older adults with subclinical hypothyroidism? J Gen Intern Med 1996;11:744-749
58. Kong WM, Sheikh MH, Lumb PJ, et al. A 6-month randomized trial of thyroxine treatment in women with mild subclinical hypothyroidism. Am J Med 2002;112:348-354
59. Meier C, Staub JJ, Roth CB, et al. TSH-controlled L-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypothyroidism: a double blind, placebo-controlled trial (Basel Thyroid Study). J Clin Endocrinol Metab 2001;86:4860-4866
60. Caraccio N, Ferrannini E, Monzani F. Lipoprotein profile in subclinical hypothyroidism: response to levothyroxine replacement, a randomized placebo-controlled study. J Clin Endocrinol Metab 2002;87:1533-1538 (Pubitemid 34615234)
61. Monzani F, Caraccio N, Kozàkowà M, et al. Effect of levothyroxine replacement on lipid profile and intima-media thickness in subclinical hypothyroidism: a double-blind, placebo- controlled study. J Clin Endocrinol Metab 2004;89:2099-2106
62. Iqbal A, Jorde R, Figenschau Y. Serum lipid levels in relation to serum thyroidstimulating hormone and the effect of thyroxine treatment on serum lipid levels in subjects with subclinical hypothyroidism: the Tromsø Study. J Intern Med 2006;260:53-61. (Pubitemid 43894070)
63. Tanis BC, Westendorp GJ, Smelt HM. Effect of thyroid substitution on hypercholesterolaemia in patients with subclinical hypothyroidism: a reanalysis of intervention studies. Clin Endocrinol (Oxf) 1996;44:643-649
64. Danese MD, Ladenson PW, Meinert CL, et al. Clinical review 115: effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: a quantitative review of the literature. J Clin Endocrinol Metab 2000;85:2993-3001.
65. Ridgway EC, Cooper DS, Walker H, et al. Peripheral responses to thyroid hormone before and after L-thyroxine therapy in patients with subclinical hypothyroidism. J Clin Endocrinol Metab 1981;53:1238-1242 (Pubitemid 13237561)
66. Bell GM, Todd WT, Forfar JC, et al. End-organ responses to thyroxine therapy in subclinical hypothyroidism. Clin Endocrinol (Oxf) 1985;22:83-89
67. Forfar JC, Wathen CG, Todd WT, et al. Left ventricular performance in subclinical hypothyroidism. QJM 1985;57:857-865 (Pubitemid 16179091)
68. Kahaly GJ. Cardiovascular and atherogenic aspects of subclinical hypothyroidism. Thyroid 2000;10:665-679
69. Arem R, Rokey R, Kiefe C, et al. Cardiac systolic and diastolic function at rest and exercise in subclinical hypothyroidism: effect of thyroid hormone therapy. Thyroid 1996;6:397-402. (Pubitemid 26398643)
70. Monzani F, Di Bello V, Caraccio N, et al. Effect of levothyroxine on cardiac function and structure in subclinical hypothyroidism: a double blind, placebo-controlled study. J Clin Endocrinol Metab 2001;86:1110-1115 (Pubitemid 32322990)
71. Biondi B, Fazio S, Palmieri EA, et al. Left ventricular diastolic dysfunction in patients with subclinical hypothyroidism. J Clin Endocrinol Metab 1999;84:2064-2067
72. Yazici M, Gorgulu S, Sertbas Y, et al. Effects of thyroxin therapy on cardiac function in patients with subclinical hypothyroidism: index of myocardial performance in the evaluation of left ventricular function. Int J Cardiol 2004;95:135-143 (Pubitemid 38757618)
73. Taddei S, Caraccio N, Virdis A, et al. Impaired endothelium-dependent vasodilatation in subclinical hypothyroidism: beneficial effect of levothyroxine therapy. J Clin Endocrinol Metab 2003;88:3731-3737 (Pubitemid 37034521)
74. Gharib H, Tuttle RM, Baskin HJ, et al. Consensus Statement #1: Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and The Endocrine Society. J Clin Endocrinol Metab 2005;90:581-585 (Pubitemid 40116712)
75. Vaidya B, Pearce SHS. Management of hypothyroidism in adults. BMJ 2008;337:284-289
76. Parle JV, Franklyn JA, Cross KW, et al. Prevalence and follow-up of abnormal thyrotrophin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol (Oxf) 1991;34:77-83.
77. Mariotti S, Franceschi C, Cossarizza A, et al. The aging thyroid. Endocr Rev 1995;16:686-715.
78. Sawin CT, Geller A, Wolf PA, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med 1994;331:1249-1252
79. Auer J, Scheibner P, Mische T, et al. Subclinical hyperthyroidism as a risk factor for atrial fibrillation. Am Heart J 2001;142:838-842 (Pubitemid 33016203)
80. Haentjens P, Van Meerhaeghe A, Poppe K, et al. Subclinical thyroid dysfunction and mortality: an estimate of relative and absolute excess all-cause mortality based on time-to-event data from cohort studies. Eur J Endocrinol 2008;159:329-341
81. Tauchmanovà L, Nuzzo V, Del Puente A, et al. Reduced bone mass detected by bone quantitative ultrasonometry and DEXA in pre- and postmenopausal women with endogenous subclinical hyperthyroidism. Maturitas 2004;48:299-306.
82. Grimnes G, Emaus N, Joakimsen RM, et al. The relationship between serum TSH and bone mineral density in men and postmenopausal women: the Tromsø study. Thyroid 2008;18:1147-1155
83. Faber J, Galløe AM. Changes in bone mass during prolonged subclinical hyperthyroidism due to L-thyroxine treatment: a meta-analysis. Eur J Endocrinol 1994;130:350-356 (Pubitemid 24135720)
84. Bauer DC, Ettinger B, Nevitt MC, et al. Risk for fracture in women with low serum levels of thyroid stimulating hormone. Ann intern med 2001;134:561-568 (Pubitemid 32245317)
85. Brennan MD, Powell C, Kaufman KR, et al. The impact of overt and subclinical hyperthyroidism on skeletal muscle. Thyroid 2006;16:375-380
86. Kalmijn S, Mehta KM, Pols HAP, et al. Subclinical hyperthyroidism and the risk of dementia. The Rotterdam Study. Clin Endocrinol 2000;53:733-737
87. Döbert N, Hamscho N, Menzel C, et al. Subclinical hyperthyroidism in dementia and correlation of the metabolic index in FDG-PET. Acta Med Austriaca 2003;30:130-133
88. Roberts LM, Pattison H, Roalfe A, et al. Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction? Ann Intern Med 2006;145:573-581
89. Faber J, Jensen IW, Petersen L, et al. Normalization of serum thyrotrophin by means of radioiodine treatment in subclinical hyperthyroidism: effect on bone loss in postmenopausal women. Clin Endocrinol (Oxf) 1998;48:285-290 (Pubitemid 28137639)
90. Mudde AH, Houben AJ, Nieuwenhuijzen Kruseman AC. Bone metabolism during anti-thyroid drug treatment of endogenous subclinical hyperthyroidism. Clin Endocrinol (Oxf) 1994;41:421-424
91. Buscemi S, Verga S, Cottone S, et al. Favorable clinical heart and bone effects of anti-thyroid drug therapy in endogenous subclinical hyperthyroidism. J Endocrinol Invest 2007;30:230-235
92. McDermott MT, Woodmansee WW, Haugen BR, et al. The management of subclinical hyperthyroidism by thyroid specialists. Thyroid 2003;13:1133-1139 (Pubitemid 38032398)
93. Vaidya B, Abraham P, Williams GR, et al. Radioiodine treatment for benign thyroid disorders: results of a nationwide survey of UK endocrinologists. Clin Endocrinol 2008;68:814-820 (Pubitemid 351533433)