Subclinical Hyperthyroidism: A Review of the Clinical Literature

Tsai, Karen; Leung, Angela M.

doi:10.1016/j.eprac.2021.02.002

Cited by 45Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

Subclinical Hyperthyroidism: A Review of the Clinical Literature

Tsai, Karen, Leung, Angela M.·2021·Endocrine Practice

DOI 10.1016/j.eprac.2021.02.002

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Abstract

Subclinical hyperthyroidism (SCHyper) is a biochemical diagnosis defined by decreased serum thyroid-stimulating hormone (TSH) and normal serum thyroxine (T4) and triiodothyronine (T3) concentrations. Because SCHyper can resolve, it is recommended to repeat serum TSH, T3, and T4 concentrations in 3-6 months before confirming a diagnosis of SCHyper to consider treatment. Proposed grading systems distinguish between mild (TSH 0.1-0.4 mIU/L) and severe SCHyper (TSH <0.1 mIU/L) and are used alongside the patients' age and presence of risk factors and symptoms to guide treatment. Appropriate evaluation includes investigation of the underlying cause and assessment of an individual's risk factors, in order to determine the necessity and type of treatment that may be recommended. SCHyper may be associated with increased risks of cardiovascular-related adverse outcomes, bone loss, and in some studies, cognitive decline. Treatment may include observation without therapy, the initiation of antithyroid medications, or the pursuit of radioiodine therapy or thyroid surgery. Considerations for treatment include the etiology of the SCHyper, anticipated longterm natural history of the condition, potential benefits of correcting the thyroid dysfunction, and the risks and benefits of each treatment option. The purpose of this overview is to provide a guide for clinicians evaluating and managing SCHyper in routine clinical practice.

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Authors: Tsai, K., & Leung, A. M.
Affiliations: University of California, Los Angeles (US)
Corresponding author: Leung, Angela M.
ORCID: Tsai, Karen
Leung, Angela M.
Venue: Endocrine Practice
Publisher: Elsevier BV
Published: 2021-03
Volume: 27
Issue: 3
Pages: 254-260
ISSN: 1530-891X (ISSN-L)
DOI: 10.1016/j.eprac.2021.02.002
OpenAlex: W3135868329
Semantic Scholar: eb648387d42589581e5115abafaaa95160457c99
Cited by: 45
References: 86
Citations by year: 2026: 5 · 2025: 6 · 2024: 7 · 2023: 15 · 2022: 8 · 2021: 4
FWCI: 1.30
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Endocrine Practice (publishedVersion)
PubMed (publishedVersion)
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 hyperthyroidism, thyroid-stimulating hormone, TSH suppression, antithyroid drugs, radioiodine therapy, thyroidectomy, cardiovascular risk, bone loss, cognitive decline, treatment decision-making, natural history (disease), grading system
MeSH terms: Humans, Hyperthyroidism, Iodine Radioisotopes, Thyroid Diseases, Thyrotropin, Thyroxine, Triiodothyronine

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