Subclinical Thyroid Disease: Scientific Review and Guidelines for Diagnosis and Management

Surks, Martin I.; Ortiz, Eduardo; Daniels, Gilbert H.; Sawin, Clark T.; Col, Nananda F.; Cobin, Rhoda H.; Franklyn, Jayne A.; Hershman, Jerome M.; Burman, Kenneth D.; Denke, Margo A.; Gorman, Colum; Cooper, Richard S.; Weissman, Neil J.

doi:10.1001/jama.291.2.228

Cited by 1,800Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

Subclinical Thyroid Disease: Scientific Review and Guidelines for Diagnosis and Management

Surks, Martin I., Ortiz, Eduardo, Daniels, Gilbert H., Sawin, Clark T., Col, Nananda F., Cobin, Rhoda H., Franklyn, Jayne A., Hershman, Jerome M. +5 more·2004·JAMA

DOI 10.1001/jama.291.2.228

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Abstract

CONTEXT: Patients with serum thyroid-stimulating hormone (TSH) levels outside the reference range and levels of free thyroxine (FT4) and triiodothyronine (T3) within the reference range are common in clinical practice. The necessity for further evaluation, possible treatment, and the urgency of treatment have not been clearly established. OBJECTIVES: To define subclinical thyroid disease, review its epidemiology, recommend an appropriate evaluation, explore the risks and benefits of treatment and consequences of nontreatment, and determine whether population-based screening is warranted. DATA SOURCES: MEDLINE, EMBASE, Biosis, the Agency for Healthcare Research and Quality, National Guideline Clearing House, the Cochrane Database of Systematic Reviews and Controlled Trials Register, and several National Health Services (UK) databases were searched for articles on subclinical thyroid disease published between 1995 and 2002. Articles published before 1995 were recommended by expert consultants. STUDY SELECTION AND DATA EXTRACTION: A total of 195 English-language or translated papers were reviewed. Editorials, individual case studies, studies enrolling fewer than 10 patients, and nonsystematic reviews were excluded. Information related to authorship, year of publication, number of subjects, study design, and results were extracted and formed the basis for an evidence report, consisting of tables and summaries of each subject area. DATA SYNTHESIS: The strength of the evidence that untreated subclinical thyroid disease is associated with clinical symptoms and adverse clinical outcomes was assessed and recommendations for clinical practice developed. Data relating the progression of subclinical to overt hypothyroidism were rated as good, but data relating treatment to prevention of progression were inadequate to determine a treatment benefit. Data relating a serum TSH level higher than 10 mIU/L to elevations in serum cholesterol were rated as fair but data relating to benefits of treatment were rated as insufficient. All other associations of symptoms and benefit of treatment were rated as insufficient or absent. Data relating a serum TSH concentration lower than 0.1 mIU/L to the presence of atrial fibrillation and progression to overt hyperthyroidism were rated as good, but no data supported treatment to prevent these outcomes. Data relating restoration of the TSH level to within the reference range with improvements in bone mineral density were rated as fair. Data addressing all other associations of subclinical hyperthyroid disease and adverse clinical outcomes or treatment benefits were rated as insufficient or absent. Subclinical hypothyroid disease in pregnancy is a special case and aggressive case finding and treatment in pregnant women can be justified. CONCLUSIONS: Data supporting associations of subclinical thyroid disease with symptoms or adverse clinical outcomes or benefits of treatment are few. The consequences of subclinical thyroid disease (serum TSH 0.1-0.45 mIU/L or 4.5-10.0 mIU/L) are minimal and we recommend against routine treatment of patients with TSH levels in these ranges. There is insufficient evidence to support population-based screening. Aggressive case finding is appropriate in pregnant women, women older than 60 years, and others at high risk for thyroid dysfunction.

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Serum TSH is the most sensitive test for the diagnosis and severity assessment of subclinical hyperthyroidism.
“Serum TSH is the most sensitive test for the diagnosis and severity assessment of SHyper [1,4,15,16] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [1]
In 2004, a panel of experts determined that the evidence for benefit was sufficient to warrant therapy of SH in older individuals whose serum TSH level was <0.1 mU/L.
“In 2004, a panel of experts determined that the evidence for benefit was sufficient to warrant therapy of SH in older individuals whose serum TSH level was <0.1 mU/L (427).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [427]

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2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis
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Practice Bulletin No. 183: postpartum hemorrhage
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Thyroid Disease and the Heart
Klein, I., & Danzi, S. (2007) · Circulation · doi:10.1161/circulationaha.106.678326 · Cited by 1,324 · see citing works
Subclinical Hypothyroidism and the Risk of Coronary Heart Disease and Mortality
Rodondi, N., den Elzen, W. P. J., Bauer, D. C., Cappola, A. R., Razvi, S., Walsh, J. P., Åsvold, B. O., Iervasi, G., Imaizumi, M., Collet, T.-H., et al. (2010) · JAMA · doi:10.1001/jama.2010.1361 · Cited by 1,216 · see citing works
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Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists
Bahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., Rivkees, S. A., et al. (2011) · Endocrine Practice · doi:10.4158/ep.17.3.456 · Cited by 1,098 · see citing works
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Subclinical thyroid disease
Cooper, D. S., & Biondi, B. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60276-6 · Cited by 1,039 · see citing works
Subclinical hypothyroidism and pregnancy outcomes
Casey, B. M., Dashe, J. S., Wells, C. E., McIntire, D. D., Byrd, W., Leveno, K. J., & Cunningham, F. G. (2005) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000152345.99421.22 · Cited by 903 · see citing works
Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists
The American Thyroid Association and American Association of Clinical Endocrinologists Taskforce on Hyperthyroidism and Other Causes of Thyrotoxicosis, Bahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., et al. (2011) · Thyroid · doi:10.1089/thy.2010.0417 · Cited by 898 · see citing works
Thyroid Status, Disability and Cognitive Function, and Survival in Old Age
Gussekloo, J. (2004) · JAMA · doi:10.1001/jama.292.21.2591 · Cited by 899 · see citing works
2013 ETA Guideline: Management of Subclinical Hypothyroidism
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Thyroid Status, Cardiovascular Risk, and Mortality in Older Adults
Cappola, A. R., Fried, L. P., Arnold, A. M., Danese, M. D., Kuller, L. H., Burke, G. L., Tracy, R. P., & Ladenson, P. W. (2006) · JAMA · doi:10.1001/jama.295.9.1033 · Cited by 862 · see citing works
Small Differences in Thyroid Function May Be Important for Body Mass Index and the Occurrence of Obesity in the Population
Knudsen, N., Laurberg, P., Rasmussen, L. B., Bülow, I., Perrild, H., Ovesen, L., & Jørgensen, T. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-2225 · Cited by 753 · see citing works
Age-Specific Distribution of Serum Thyrotropin and Antithyroid Antibodies in the U.S. Population: Implications for the Prevalence of Subclinical Hypothyroidism
Surks, M. I., & Hollowell, J. G. (2007) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2007-1499 · Cited by 750 · see citing works
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Thyroid hormones and cardiovascular disease
Jabbar, A., Pingitore, A., Pearce, S. H. S., Zaman, A., Iervasi, G., & Razvi, S. (2017) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2016.174 · Cited by 729 · see citing works
Subclinical hyperthyroidism and the risk of coronary heart disease and mortality
Collet, T.-H., Gussekloo, J., Bauer, D. C., den Elzen, W. P. J., Cappola, A. R., Balmer, P., Iervasi, G., Åsvold, B. O., Sgarbi, J. A., Völzke, H., et al. (2012) · Archives of Internal Medicine · doi:10.1001/archinternmed.2012.402 · Cited by 572 · see citing works
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Subclinical thyroid dysfunction as a risk factor for cardiovascular disease
Walsh, J. P., Bremner, A. P., Bulsara, M. K., O’Leary, P., Leedman, P. J., Feddema, P., & Michelangeli, V. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.21.2467 · Cited by 536 · see citing works
Significance of (sub)clinical thyroid dysfunction and thyroid autoimmunity before conception and in early pregnancy: a systematic review
van den Boogaard, E., Vissenberg, R., Land, J. A., van Wely, M., van der Post, J. A. M., Goddijn, M., & Bisschop, P. H. (2011) · Human Reproduction Update · doi:10.1093/humupd/dmr024 · Cited by 528 · see citing works
Subclinical Thyroid Dysfunction and the Risk of Heart Failure Events: An Individual Participant Data Analysis From 6 Prospective Cohorts
Gencer, B., Collet, T.-H., Virgini, V., Bauer, D. C., Gussekloo, J., Cappola, A. R., Nanchen, D., den Elzen, W. P. J., Balmer, P., Luben, R. N., et al. (2012) · Circulation · doi:10.1161/circulationaha.112.096024 · Cited by 517 · see citing works
Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death
Rodondi, N., Newman, A. B., Vittinghoff, E., de Rekeneire, N., Satterfield, S., Harris, T. B., & Bauer, D. C. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.21.2460 · Cited by 503 · see citing works
Meta-analysis: Subclinical Thyroid Dysfunction and the Risk for Coronary Heart Disease and Mortality
Ochs, N., Auer, R., Bauer, D. C., Nanchen, D., Gussekloo, J., Cornuz, J., & Rodondi, N. (2008) · Annals of Internal Medicine · doi:10.7326/0003-4819-148-11-200806030-00225 · Cited by 477 · see citing works
The Evidence for a Narrower Thyrotropin Reference Range Is Compelling
Wartofsky, L., & Dickey, R. A. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-0455 · Cited by 424 · see citing works
Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society
Gharib, H., Tuttle, R. M., Baskin, H. J., Fish, L. H., Singer, P. A., & McDermott, M. T. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2004-1231 · Cited by 394 · see citing works
The physiology of endocrine systems with ageing
van den Beld, A. W., Kaufman, J.-M., Zillikens, M. C., Lamberts, S. W. J., Egan, J. M., & van der Lely, A. J. (2018) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(18)30026-3 · Cited by 349 · see citing works
The protocols for the 10/66 dementia research group population-based research programme
Prince, M., Ferri, C. P., Acosta, D., Albanese, E., Arizaga, R., Dewey, M., Gavrilova, S. I., Guerra, M., Huang, Y., Jacob, K., et al. (2007) · BMC Public Health · doi:10.1186/1471-2458-7-165 · Cited by 357 · see citing works
Subclinical Hyperthyroidism and Pregnancy Outcomes
Casey, B. M., Dashe, J. S., Wells, C. E., McIntire, D. D., Leveno, K. J., & Cunningham, F. G. (2006) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000197991.64246.9a · Cited by 358 · see citing works
The association between TSH within the reference range and serum lipid concentrations in a population-based study. The HUNT Study
Åsvold, B. O., Vatten, L. J., Nilsen, T. I. L., & Bjøro, T. (2007) · European Journal of Endocrinology · doi:10.1530/eje.1.02333 · Cited by 350 · see citing works
The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism
Biondi, B., Bartalena, L., Cooper, D. S., Hegedüs, L., Laurberg, P., & Kahaly, G. J. (2015) · European Thyroid Journal · doi:10.1159/000438750 · Cited by 323 · see citing works
Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis: A Systematic Review and Meta-analysis
Siegmann, E.-M., Müller, H. H. O., Luecke, C., Philipsen, A., Kornhuber, J., & Grömer, T. W. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.0190 · Cited by 304 · see citing works
Falling Threshold for Treatment of Borderline Elevated Thyrotropin Levels—Balancing Benefits and Risks: Evidence From a Large Community-Based Study
Taylor, P. N., Iqbal, A., Minassian, C., Sayers, A., Draman, M. S., Greenwood, R., Hamilton, W., Okosieme, O., Panicker, V., Thomas, S. L., et al. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.11312 · Cited by 300 · see citing works
Subclinical and Overt Thyroid Dysfunction and Risk of All-Cause Mortality and Cardiovascular Events: A Large Population Study
Selmer, C., Olesen, J. B., Hansen, M. L., von Kappelgaard, L. M., Madsen, J. C., Hansen, P. R., Pedersen, O. D., Faber, J., Torp-Pedersen, C., & Gislason, G. H. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-4184 · Cited by 288 · see citing works
The Thyrotropin Reference Range Should Remain Unchanged
Surks, M. I., Goswami, G., & Daniels, G. H. (2005) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2005-0170 · Cited by 287 · see citing works
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Association between increased mortality and mild thyroid dysfunction in cardiac patients
Iervasi, G. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.14.1526 · Cited by 285 · see citing works
A Review of the Clinical Consequences of Variation in Thyroid Function Within the Reference Range
Taylor, P. N., Razvi, S., Pearce, S. H., & Dayan, C. M. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-1315 · Cited by 274 · see citing works
Levothyroxine Treatment of Subclinical Hypothyroidism, Fatal and Nonfatal Cardiovascular Events, and Mortality
Razvi, S., Weaver, J. U., Butler, T. J., & Pearce, S. H. S. (2012) · Archives of Internal Medicine · doi:10.1001/archinternmed.2012.1159 · Cited by 266 · see citing works
Thyrotoxicosis
Franklyn, J. A., & Boelaert, K. (2012) · The Lancet · doi:10.1016/s0140-6736(11)60782-4 · Cited by 262 · see citing works
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Treatment with thyroid hormone
Biondi, B., & Wartofsky, L. (2014) · Endocrine Reviews · doi:10.1210/er.2013-1083 · Cited by 259 · see citing works
Subclinical hypothyroidism and type 2 diabetes: A systematic review and meta-analysis
Han, C., He, X., Xia, X., Li, Y., Shi, X., Shan, Z., & Teng, W. (2015) · PLoS ONE · doi:10.1371/journal.pone.0135233 · Cited by 258 · see citing works
Extreme Longevity Is Associated with Increased Serum Thyrotropin
Atzmon, G., Barzilai, N., Hollowell, J. G., Surks, M. I., & Gabriely, I. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-2325 · Cited by 260 · see citing works
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Age- and Race-Based Serum Thyrotropin Reference Limits
Surks, M. I., & Boucai, L. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-1845 · Cited by 258 · see citing works
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Thyrotropin and thyroid antibodies as predictors of hypothyroidism: a 13-year, longitudinal study of a community-based cohort using current immunoassay techniques
Walsh, J. P., Bremner, A. P., Feddema, P., Leedman, P. J., Brown, S. J., & O'Leary, P. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-1977 · Cited by 252 · see citing works
Thyroid Function and Prevalence of Anti-Thyroperoxidase Antibodies in a Population with Borderline Sufficient Iodine Intake: Influences of Age and Sex
Hoogendoorn, E. H., Hermus, A. R., de Vegt, F., Ross, H. A., Verbeek, A. L., Kiemeney, L. A., Swinkels, D. W., Sweep, F. C., & den Heijer, M. (2006) · Clinical Chemistry · doi:10.1373/clinchem.2005.055194 · Cited by 255 · see citing works
Medical comorbidities in children and adolescents with autism spectrum disorders and attention deficit hyperactivity disorders: a systematic review
Muskens, J. B., Velders, F. P., & Staal, W. G. (2017) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-017-1020-0 · Cited by 232 · see citing works
Serum Thyrotropin Measurements in the Community: Five-Year Follow-up in a Large Network of Primary Care Physicians
Meyerovitch, J. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.14.1533 · Cited by 245 · see citing works
New Reference Intervals for Thyrotropin and Thyroid Hormones Based on National Academy of Clinical Biochemistry Criteria and Regular Ultrasonography of the Thyroid
Kratzsch, J., Fiedler, G. M., Leichtle, A., Brügel, M., Buchbinder, S., Otto, L., Sabri, O., Matthes, G., & Thiery, J. (2005) · Clinical Chemistry · doi:10.1373/clinchem.2004.047399 · Cited by 235 · see citing works
Is Subclinical Thyroid Dysfunction in the Elderly Associated with Depression or Cognitive Dysfunction?
Roberts, L. M., Pattison, H., Roalfe, A., Franklyn, J., Wilson, S., Hobbs, F. D. R., & Parle, J. V. (2006) · Annals of Internal Medicine · doi:10.7326/0003-4819-145-8-200610170-00006 · Cited by 239 · see citing works
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Thyroid Diseases and Cerebrovascular Disease
Squizzato, A., Gerdes, V. E. A., Brandjes, D. P. M., Büller, H. R., & Stam, J. (2005) · Stroke · doi:10.1161/01.str.0000181772.78492.07 · Cited by 236 · see citing works
Lithium and thyroid
Lazarus, J. H. (2009) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2009.06.002 · Cited by 230 · see citing works
Association Between Serum Free Thyroxine Concentration and Atrial Fibrillation
Gammage, M. D. (2007) · Archives of Internal Medicine · doi:10.1001/archinte.167.9.928 · Cited by 225 · see citing works
Thyroid Function and the Risk of Alzheimer Disease<subtitle>The Framingham Study</subtitle>
Tan, Z. S. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.14.1514 · Cited by 225 · see citing works
Subclinical Hypothyroidism Is Associated With Increased Risk for All-Cause and Cardiovascular Mortality in Adults
Tseng, F.-Y., Lin, W.-Y., Lin, C.-C., Lee, L.-T., Li, T.-C., Sung, P.-K., & Huang, K.-C. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2012.03.047 · Cited by 212 · see citing works
Subclinical hyperthyroidism: clinical features and treatment options
Biondi, B., Palmieri, E. A., Klain, M., Schlumberger, M., Filetti, S., & Lombardi, G. (2005) · European Journal of Endocrinology · doi:10.1530/eje.1.01809 · Cited by 217 · see citing works
Hypothyroidism: etiology, diagnosis, and management
Almandoz, J. P., & Gharib, H. (2012) · Medical Clinics of North America · doi:10.1016/j.mcna.2012.01.005 · Cited by 216 · see citing works
Is there a need to redefine the upper normal limit of TSH?
Brabant, G., Beck-Peccoz, P., Jarzab, B., Laurberg, P., Orgiazzi, J., Szabolcs, I., Weetman, A. P., & Wiersinga, W. M. (2006) · European Journal of Endocrinology · doi:10.1530/eje.1.02136 · Cited by 211 · see citing works
Subclinical Thyroid Dysfunction and the Risk of Heart Failure in Older Persons at High Cardiovascular Risk
Nanchen, D., Gussekloo, J., Westendorp, R. G. J., Stott, D. J., Jukema, J. W., Trompet, S., Ford, I., Welsh, P., Sattar, N., Macfarlane, P. W., et al. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-1978 · Cited by 211 · see citing works
The Natural History of Subclinical Hypothyroidism in the Elderly: The Cardiovascular Health Study
Somwaru, L. L., Rariy, C. M., Arnold, A. M., & Cappola, A. R. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-3047 · Cited by 210 · see citing works
Thyroid-Stimulating Hormone in Singleton and Twin Pregnancy: Importance of Gestational Age–Specific Reference Ranges
Dashe, J. S., Casey, B. M., Wells, C. E., McIntire, D. D., Byrd, E. W., Leveno, K. J., & Cunningham, F. G. (2005) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000175836.41390.73 · Cited by 203 · see citing works
Older Subjects with Hyperthyroidism Present with a Paucity of Symptoms and Signs: A Large Cross-Sectional Study
Boelaert, K., Torlinska, B., Holder, R. L., & Franklyn, J. A. (2010) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-2495 · Cited by 196 · see citing works
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Subclinical hypothyroidism is a risk factor for nephropathy and cardiovascular diseases in type 2 diabetic patients.
Chen, H. ‐., Wu, T. ‐. J., Jap, T. ‐., Lu, R. ‐., Wang, M. ‐., Chen, R. ‐., & Lin, H. ‐. (2007) · Diabetic Medicine · doi:10.1111/j.1464-5491.2007.02270.x · Cited by 189 · see citing works
Thyroid nodule guidelines: agreement, disagreement and need for future research
Paschke, R., Hegedüs, L., Alexander, E., Valcavi, R., Papini, E., & Gharib, H. (2011) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2011.1 · Cited by 184 · see citing works
Management of hypothyroidism in adults
Vaidya, B., & Pearce, S. H. S. (2008) · BMJ · doi:10.1136/bmj.a801 · Cited by 178 · see citing works
Subclinical Hypothyroidism and the Risk of Cardiovascular Disease and All-Cause Mortality: A Meta-Analysis of Prospective Cohort Studies
Moon, S., Kim, M. J., Yu, J. M., Yoo, H. J., & Park, Y. J. (2018) · Thyroid · doi:10.1089/thy.2017.0414 · Cited by 175 · see citing works
Subclinical thyroid dysfunction and mortality: an estimate of relative and absolute excess all-cause mortality based on time-to-event data from cohort studies
Haentjens, P., Van Meerhaeghe, A., Poppe, K., & Velkeniers, B. (2008) · European Journal of Endocrinology · doi:10.1530/eje-08-0110 · Cited by 174 · see citing works
The Impact of Overt and Subclinical Hyperthyroidism on Skeletal Muscle
Brennan, M. D., Powell, C., Kaufman, K. R., Sun, P. C., Bahn, R. S., & Nair, K. S. (2006) · Thyroid · doi:10.1089/thy.2006.16.375 · Cited by 155 · see citing works
Endogenous subclinical thyroid disorders, physical and cognitive function, depression, and mortality in older individuals
de Jongh, R. T., Lips, P., van Schoor, N. M., Rijs, K. J., Deeg, D. J. H., Comijs, H. C., Kramer, M. H. H., Vandenbroucke, J. P., & Dekkers, O. M. (2011) · European Journal of Endocrinology · doi:10.1530/eje-11-0430 · Cited by 157 · see citing works
Does subclinical hypothyroidism affect cardiac pump performance?
Ripoli, A., Pingitore, A., Favilli, B., Bottoni, A., Turchi, S., Osman, N. F., De Marchi, D., Lombardi, M., L'Abbate, A., & Iervasi, G. (2005) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2004.10.044 · Cited by 157 · see citing works
Effects of amiodarone therapy on thyroid function
Cohen-Lehman, J., Dahl, P., Danzi, S., & Klein, I. (2010) · Nature Reviews Endocrinology · doi:10.1038/nrendo.2009.225 · Cited by 157 · see citing works
Levothyroxine dose and risk of fractures in older adults: nested case-control study
Turner, M. R., Camacho, X., Fischer, H. D., Austin, P. C., Anderson, G. M., Rochon, P. A., & Lipscombe, L. L. (2011) · BMJ · doi:10.1136/bmj.d2238 · Cited by 152 · see citing works
Reference limits of serum TSH and free T4 are significantly influenced by race and age in an urban outpatient medical practice
Boucai, L., & Surks, M. I. (2009) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2008.03390.x · Cited by 141 · see citing works
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Hypothyroidism in the elderly: diagnosis and management
Bensenor, I., Lotufo, P., & Diaz-Olmos (2012) · Clinical Interventions in Aging · doi:10.2147/cia.s23966 · Cited by 139 · see citing works
Preservation of Renal Function by Thyroid Hormone Replacement Therapy in Chronic Kidney Disease Patients with Subclinical Hypothyroidism
Shin, D. H., Lee, M. J., Kim, S. J., Oh, H. J., Kim, H. R., Han, J. H., Koo, H. M., Doh, F. M., Park, J. T., Han, S. H., et al. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-1663 · Cited by 138 · see citing works
Blood coagulation, fibrinolytic activity and lipid profile in subclinical thyroid disease: subclinical hyperthyroidism increases plasma factor X activity
Erem, C. (2006) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2006.02464.x · Cited by 136 · see citing works
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Authors: Surks, M. I., Ortiz, E., Daniels, G. H., Sawin, C. T., Col, N. F., Cobin, R. H., Franklyn, J. A., Hershman, J. M., Burman, K. D., Denke, M. A., Gorman, C., Cooper, R. S., & Weissman, N. J.
Affiliations: Albert Einstein College of Medicine (US)
Harvard University (US)
United States Department of Veterans Affairs (US)
Icahn School of Medicine at Mount Sinai (US)
University of Birmingham (GB)
University of California, Los Angeles (US)
MedStar Washington Hospital Center (US)
The University of Texas at San Antonio (US)
Mayo Clinic (US)
Loyola University Chicago (US)
Georgetown University (US)
ORCID: Daniels, Gilbert H.
Col, Nananda F.
Burman, Kenneth D.
Cooper, Richard S.
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2004-01-14
Volume: 291
Issue: 2
Pages: 228
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.291.2.228
OpenAlex: W2107116656
Cited by: 1,800
References: 80
Citations by year: 2026: 19 · 2025: 29 · 2024: 36 · 2023: 42 · 2022: 55 · 2021: 65 · 2020: 58 · 2019: 53 · 2018: 74 · 2017: 75 · 2016: 100 · 2015: 96 · 2014: 109 · 2013: 105 · 2012: 123
FWCI: 65.32
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
Civil War Book Review (submittedVersion)
University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
Keywords: subclinical thyroid dysfunction, subclinical hypothyroidism, subclinical hyperthyroidism, thyroid-stimulating hormone, free thyroxine, triiodothyronine, atrial fibrillation, serum cholesterol, bone mineral density, thyroid screening, pregnancy, treatment risks and benefits
MeSH terms: Humans, Hyperthyroidism, Hypothyroidism, Mass Screening, Reference Values, Risk, Thyroid Diseases, Thyrotropin

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Subclinical Thyroid Disease: Scientific Review and Guidelines for Diagnosis and Management

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