Subclinical Hyperthyroidism in Patients with Nodular Goiter Represents a Hypermetabolic State
Abstract
The aim of the study was to examine the metabolic status in patients with suppressed TSH but values of FT4I and T3 within the reference range (subclinical hyperthyroidism [sH]). Thirteen patients and 13 control persons with nodular goiter were included. The metabolic state was determined by measurements of basal oxygen consumption (VO2), bone mineral density (BMD), and the circadian variation of TSH. Further was the pituitary thyroid axis examined by studying the effect of lowering thyroid hormones by methimazol treatment. The circadian variation of TSH varied from that of normal persons as the night surge was abolished. The basal VO2 was significantly higher and BMD was significantly lower in patients with sH compared to control persons. Restoration of TSH by lowering of thyroid hormone concentrations lead to a normalization of VO2 and restoration of the circadian variation of TSH. The preserved pituitary thyroid axis, the abolished circadian TSH variation, the increased VO2, and decreased BMD in patients with suppressed TSH, but peripheral thyroid hormone concentrations within the reference range, indicate a hyper metabolic state, which might reflect either an altered cellular set point or an increased sensitivity towards thyroid hormones in peripheral cells and in the thyrotrope cells.
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Endogenous subclinical hyperthyroidism, in contrast to exogenous LT4 suppressive therapy, may induce long-term alterations in energy expenditure and body composition.
“These studies suggest that endogenous subclinical hyperthyroidism, in contrast to exogenous LT4 suppressive therapy, may induce long-term alterations in energy expenditure and body composition.”
From Effects of levothyroxine replacement or suppressive therapy on energy expenditure and body composition (2016) · cites this paper as [17]
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Thyroid Hormone Diseases and Osteoporosis
Delitala, A. P., Scuteri, A., & Doria, C. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9041034 · Cited by 220 · see citing works
“Decreased BMD was observed in a small group of patients with subclinical hyperthyroidism with nodular goiter [50].”
BackgroundThyroid Hormone Action and Energy Expenditure
Yavuz, S., Prado, S. R. S. N. D., & Celi, F. S. (2019) · Journal of the Endocrine Society · doi:10.1210/js.2018-00423 · Cited by 103 · see citing works
“Although the changes in EE during clinical hyperthyroidism have been clearly demonstrated in clinical studies, the literature on the effects of subclinical hyperthyroidism is very limited and inconclusive [42, 43].”
BackgroundSamuels, M. H., Kolobova, I., Smeraglio, A., Peters, D., Purnell, J. Q., & Schuff, K. G. (2016) · Thyroid · doi:10.1089/thy.2015.0345 · Cited by 87 · see citing works
“Subjects in one study were given methimazole, and basal VO2 normalized when they became euthyroid (17).”
BackgroundApproach to the Patient with Subclinical Hyperthyroidism
Cooper, D. S. (2007) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-2472 · Cited by 83 · see citing works
“142 ml O2 /min m(2)) after treatment with methimazole (42).”
BackgroundMikosch, P., Kerschan‐Schindl, K., Woloszczuk, W., Stettner, H. M., Kudlacek, S., Kresnik, E., Gallowitsch, H. J., Lind, P., & Pietschmann, P. (2008) · Thyroid · doi:10.1089/thy.2007.0186 · Cited by 24 · see citing works
“Furthermore, Kvetny (32) showed that in patients with a goiter on suppLT 4 therapy the bone mineral density (BMD) was significantly decreased in comparison to euthyroid controls.”
InfluentialReceptor activator of nuclear factor κB ligand and osteoprotegerin in men with thyroid cancer
Mikosch, P., Igerc, I., Kudlacek, S., Woloszczuk, W., Gallowitsch, H. J., Kresnik, E., Stettner, H. M., Grimm, G., Lind, P., & Pietschmann, P. (2006) · European Journal of Clinical Investigation · doi:10.1111/j.1365-2362.2006.01678.x · Cited by 15 · see citing works
Effects of thyroid disorders on the bone
Mikosch, P. (2005) · Wiener Medizinische Wochenschrift · doi:10.1007/s10354-005-0222-0 · Cited by 7 · see citing works
Zhang, L., Ma, C., Yin, X., Zhang, F., Fang, X., Zhang, C., Shang, L., & Ma, L. (2025) · Scientific Reports · doi:10.1038/s41598-025-00448-x · Cited by 2 · see citing works
“A study included 13 patients diagnosed with nodular goitre accompanied by subclinical hyperthyroidism reported that BMD was decreased (TSH range 0.76–3.9 uIU/mL) 29 .”
Influential
- Authors
- Kvetny, J.
- Affiliations
- Hospital South West Jutland (DK)
- Corresponding author
- Kvetny, J.
- ORCID
- Kvetny, J.
- Venue
- Experimental and Clinical Endocrinology & Diabetes
- Publisher
- Georg Thieme Verlag KG
- Published
- 2005-03-17
- Volume
- 113
- Issue
- 02
- Pages
- 122-126
- ISSN
- 0947-7349 (ISSN-L)
- 1439-3646
- OpenAlex
- W1991713554
- Cited by
- 8
- References
- 0
- Citations by year
- 2025: 1 · 2020: 1 · 2019: 1 · 2015: 1
- FWCI
- 0.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Experimental and Clinical Endocrinology & Diabetes (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, nodular goiter, hypermetabolism, basal oxygen consumption, bone mineral density, pituitary-thyroid axis, methimazole, thyroid hormone sensitivity
- MeSH terms
- Circadian Rhythm, Energy Metabolism, Goiter, Nodular, Humans, Hyperparathyroidism, Oxygen Consumption, Reference Values, Thyroid Hormones, Thyrotropin, Bone Density
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