The DOI matches its Crossref record; 150 of the 151 references it cites were found in a registry or an index.
Subclinical thyroid disease
Abstract
Subclinical thyroid diseases--subclinical hyperthyroidism and subclinical hypothyroidism--are common clinical entities that encompass mild degrees of thyroid dysfunction. The clinical significance of mild thyroid overactivity and underactivity is uncertain, which has led to controversy over the appropriateness of diagnostic testing and possible treatment. In this Seminar, we discuss the definition, epidemiology, differential diagnoses, risks of progression to overt thyroid disease, potential effects on various health outcomes, and management of subclinical hyperthyroidism and subclinical hypothyroidism. Treatment recommendations are based on the degree to which thyroid-stimulating hormone concentrations have deviated from normal and underlying comorbidities. Large-scale randomised trials are urgently needed to inform how to best care for individuals with subclinical thyroid disease.
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In the citing paper
“Finally, subnormal serum TSH concentrations are frequently observed in black people and in some healthy cigarette smokers [3,5,25] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [5]
In the citing paper
“Serum free T 4 and free T 3 levels are generally normal to low-normal in people with the latter conditions [3,5,18] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [5]
In the citing paper
“The degree of TSH suppression is the best parameter for predicting the progression from subclinical to overt hyperthyroidism [3,5,18,31] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [5]
In the citing paper
“Endogenous SHyper is most commonly due to Graves' disease (GD), toxic adenoma (TA) and toxic multinodular goitre (MNG) [3,5] ( table 1 ).”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [5]
In the citing paper
“Differences in the degree of TSH suppression, causes of SHyper, patient age and duration of TSH suppression may influence the adverse consequences of Endo SHyper [3,5,30] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [5]
In the citing paper
“SHyper may progress to overt hyperthyroidism and may be associated with increased cardiovascular and skeletal risk [3,5,18] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [5]
In the citing paper
“Autoimmune hypothyroidism is the most common cause of hypothyroidism at all ages and the prevalence of thyroid autoimmunity increases with aging (23, 26, 27).”
From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [27]
In the citing paper
“The presence of thyroid antibodies, which is associated with an increased risk of progression from subclinical to overt hypothyroidism, suggests a closer monitoring of thyroid function in subjects with thyroid antibodies (27, 52).”
From Levothyroxine therapy in elderly patients with hypothyroidism (2021) · cites this paper as [27]
In the citing paper
“Other epidemiological studies4,5,6,7 have also found an association between subclinical hypothyroidism or high-normal TSH concentrations (ie, serum TSH concentrations at the upper end of the normal range) and dyslipidemia, increased insulin resistance, and hypertension—components of metabolic syndrome.”
From Association of subclinical hypothyroidism and cardiovascular disease with mortality (2020) · cites this paper as [4]
In the citing paper
“Elevated thyroid hormone levels have been reported to negatively affect quality of life and cognitive function as well as the cardiovascular system in young and middle-aged populations.4”
From Association of subclinical hypothyroidism and cardiovascular disease with mortality (2020) · cites this paper as [4]
In the citing paper
“In general, it is well established that women are at an increased risk of progression from subclinical to overt hypothyroidism.4”
From Association of subclinical hypothyroidism and cardiovascular disease with mortality (2020) · cites this paper as [4]
In the citing paper
“A previous meta-analysis8 reported that subclinical hypothyroidism is associated with higher CVD risk, and thus treatment with levothyroxine is recommended when serum TSH concentrations reach 10 mIU/L or greater.4,31”
From Association of subclinical hypothyroidism and cardiovascular disease with mortality (2020) · cites this paper as [4]
In the citing paper
“The evidence for benefit in randomized controlled trials of thyroid hormone treatment in subclinical hypothyroidism is inconsistent and further studies are needed.3,15”
From Management of primary hypothyroidism: statement by the British Thyroid Association Executive Committee (2016) · cites this paper as [3]
In the citing paper
“Trials of levothyroxine in SCH using surrogate markers have shown improvement in LV function, vascular endothelial function, atherogenic lipid particles, or cardiac mitochondrial function (4,91,105-108).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [106]
In the citing paper
“It has widely been assumed that these associations are caused by subclinical hyperthyroidism with detrimental effects of excess thyroid hormone, for instance its proarrhythmic effect on the heart leading to AF, despite the fact that serum thyroid hormones are within reference range (1, 13–15, 29, 41, 42).”
From Serum Thyroid Function, Mortality and Disability in Advanced Old Age: The Newcastle 85+ Study (2016) · cites this paper as [1]
In the citing paper
“Mild subclinical thyroid disease can progress at a low rate, suggesting a long-term screening program.”
From Thyroid dysfunction and diabetes mellitus: two closely associated disorders (2019) · cites this paper as [4]
In the citing paper
“Most studies of endogenous SH show decreased bone mineral density in postmenopausal women, but not in men or premenopausal women (406).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [406]
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Metadata
- Authors
- Cooper, D. S., & Biondi, B.
- Affiliations
- Johns Hopkins University (US)
- University of Naples Federico II (IT)
- Corresponding author
- Cooper, David S
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 379
- Issue
- 9821
- Pages
- 1142-1154
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2160393206
- Cited by
- 1,039
- References
- 151
- Citations by year
- 2026: 29 · 2025: 56 · 2024: 64 · 2023: 107 · 2022: 72 · 2021: 82 · 2020: 69 · 2019: 86 · 2018: 68 · 2017: 61 · 2016: 74 · 2015: 71 · 2014: 74 · 2013: 79 · 2012: 33
- FWCI
- 11.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (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, subclinical hypothyroidism, thyroid dysfunction, thyroid-stimulating hormone, health outcomes, treatment guidelines, comorbidities, differential diagnosis
- MeSH terms
- Atrial Fibrillation, Cardiovascular Diseases, Diagnosis, Differential, Female, Humans, Hyperthyroidism, Hypothyroidism, Nutrition Surveys, Osteoporosis, Pregnancy, Pregnancy Complications, Quality of Life, Thyroid Hormones, Thyroiditis, Thyrotropin, Thyroxine, United States, Comorbidity, Disease Progression, Dyslipidemias
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