Subclinical Hypothyroidism
Abstract
I agree with Rosario’s comment that ultrasonographic examination of the thyroid can provide additional evidence of thyroid autoimmunity. However, this examination is associated with a risk of incidental findings. A large proportion of diagnoses of thyroid cancer in the past two decades were probably due to diagnostic changes after the introduction of ultrasonographic examination of the neck in the 1980s. This is best illustrated by data from South Korea, where a large-scale introduction of ultrasonographic examination of the thyroid (ultrasonographic examination of the neck was offered at a low cost in addition to organized screening programs for other cancers) resulted in a rate of thyroid-cancer diagnoses in 2011 that was 15 times that observed in 1993.3 Despite this dramatic increase in incidence, thyroid cancer–specific mortality remained stable; this clearly suggests overdiagnosis of indolent thyroid cancers. It is estimated that overdiagnosis accounts for the majority of cases of thyroid cancer in many Western countries.4 In the context of guidelines from professional societies that emphasize avoidance of both overdiagnosis and overtreatment of thyroid cancer,5 ultrasonographic examination of the neck should not be performed routinely in the management of subclinical hypothyroidism unless there are additional clinical indications.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the elderly, the upper bound of the TSH reference interval progressively increases with age.
“At the other age extreme, in the elderly, the upper bound of the TSH reference interval progressively increases with age and should be reflected in laboratory reports and taken into consideration for clinical interpretation of TSH test results.”
Cites
Haugen, B. R., Alexander, E. K., Bible, K. C., Doherty, G. M., Mandel, S. J., Nikiforov, Y. E., Pacini, F., Randolph, G. W., Sawka, A. M., Schlumberger, M., et al. (2016) · Thyroid® · doi:10.1089/thy.2015.0020 · Cited by 16,535 · see citing works
The Clinical Significance of Subclinical Thyroid Dysfunction
Biondi, B., & Cooper, D. S. (2008) · Endocrine Reviews · doi:10.1210/er.2006-0043 · Cited by 1,418 · see citing works
Korea's Thyroid-Cancer “Epidemic” — Screening and Overdiagnosis
Ahn, H. S., Kim, H. J., & Welch, H. G. (2014) · New England Journal of Medicine · doi:10.1056/nejmp1409841 · Cited by 1,238 · see citing works
Worldwide Thyroid-Cancer Epidemic? The Increasing Impact of Overdiagnosis
Vaccarella, S., Franceschi, S., Bray, F., Wild, C. P., Plummer, M., & Dal Maso, L. (2016) · New England Journal of Medicine · doi:10.1056/nejmp1604412 · Cited by 1,145 · see citing works
Vaccarella, S., Maso, L. D., Laversanne, M., Bray, F., Plummer, M., & Franceschi, S. (2015) · Thyroid · doi:10.1089/thy.2015.0116 · Cited by 361 · see citing works
Peeters, R. P. (2017) · New England Journal of Medicine · doi:10.1056/nejmcp1611144 · Cited by 279 · see citing works
Self-citationThe Value of Ultrasonography in Predicting Autoimmune Thyroid Disease
Pedersen, O. M., Aardal, N. P., Larssen, T. B., Varhaug, J. E., Myking, O. L., & Vik‐Mo, H. (2000) · Thyroid · doi:10.1089/thy.2000.10.251 · Cited by 271 · see citing works
Natural History of Mild Subclinical Hypothyroidism: Prognostic Value of Ultrasound
Rosário, P. W., Bessa, B., Valadão, M. M. A., & Purisch, S. (2008) · Thyroid · doi:10.1089/thy.2008.0221 · Cited by 78 · see citing works
Imaizumi, M., Sera, N., Ueki, I., Horie, I., Ando, T., Usa, T., Ichimaru, S., Nakashima, E., Hida, A., Soda, M., et al. (2011) · Thyroid · doi:10.1089/thy.2010.0411 · Cited by 73 · see citing works
Natural history of subclinical hypothyroidism with TSH ≤10 mIU/l: a prospective study
Rosário, P. W., Carvalho, M. U. W. B. D., & Calsolari, M. R. (2015) · Clinical Endocrinology · doi:10.1111/cen.12939 · Cited by 33 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Thayakaran, R., Adderley, N. J., Sainsbury, C., Torlinska, B., Boelaert, K., Šumilo, D., Price, M., Thomas, G. N., Toulis, K. A., & Nirantharakumar, K. (2019) · BMJ · doi:10.1136/bmj.l4892 · Cited by 138 · see citing works
Chen, W., Li, J., Peng, S., Hong, S., Xu, H.-Y., Lin, B., Liang, X., Liu, Y., Liang, J., Zhang, Z., et al. (2021) · JAMA Surgery · doi:10.1001/jamasurg.2021.6442 · Cited by 116 · see citing works
Prevalence of undiagnosed hypothyroidism in Europe: a systematic review and meta-analysis.
Mendes, D., Alves, C., Silverio, N., & Batel Marques, F. (2019) · European Thyroid Journal · doi:10.1159/000499751 · Cited by 113 · see citing works
Van Uytfanghe, K., Ehrenkranz, J., Halsall, D., Hoff, K., Loh, T. P., Spencer, C. A., Köhrle, J., & ATA Thyroid Function Tests Writing Group (2023) · Thyroid® · doi:10.1089/thy.2023.0169 · Cited by 100 · see citing works
Clinical aspects of thyroid function during ageing
Chaker, L., Cappola, A. R., Mooijaart, S. P., & Peeters, R. P. (2018) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(18)30028-7 · Cited by 94 · see citing works
Self-citationMcDermott, M. T. (2020) · Annals of Internal Medicine · doi:10.7326/aitc202007070 · Cited by 79 · see citing works
Pathogenesis of hypothyroidism-induced NAFLD: Evidence for a distinct disease entity?
Lonardo, A., Ballestri, S., Mantovani, A., Nascimbeni, F., Lugari, S., & Targher, G. (2019) · Digestive and Liver Disease · doi:10.1016/j.dld.2018.12.014 · Cited by 76 · see citing works
Levothyroxine for the Treatment of Subclinical Hypothyroidism and Cardiovascular Disease
Sue, L. Y., & Leung, A. M. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.591588 · Cited by 76 · see citing works
Stratigou, T., Dalamaga, Μ., Antonakos, G., Μαρίνου, Ι., Vogiatzakis, E., Christodoulatos, G. S., Karampela, Ι., & Papavassiliou, A. G. (2018) · Endocrine · doi:10.1007/s12020-018-1550-3 · Cited by 49 · see citing works
L-Thyroxine Therapy for Older Adults With Subclinical Hypothyroidism and Hypothyroid Symptoms
de Montmollin, M., Feller, M., Beglinger, S., McConnachie, A., Aujesky, D., Collet, T., Ford, I., Gussekloo, J., Kearney, P. M., Carthy, V. J. C. M., et al. (2020) · Annals of Internal Medicine · doi:10.7326/m19-3193 · Cited by 36 · see citing works
Perros, P., Nagy, E. V., Papini, E., Van Der Feltz-Cornelis, C. M., Weetman, A. P., Hay, H. A., Abad-Madroñero, J., Tallett, A. J., Bilas, M., Lakwijk, P., et al. (2023) · Thyroid · doi:10.1089/thy.2022.0641 · Cited by 27 · see citing works
Lai, R., Yin, B., Feng, Z., Deng, X., Lv, X., Zhong, Y., & Peng, D. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1332383 · Cited by 22 · see citing works
Decision Making in Subclinical Thyroid Disease
Evron, J. M., & Papaleontiou, M. (2021) · Medical Clinics of North America · doi:10.1016/j.mcna.2021.05.014 · Cited by 23 · see citing works
Zhao, C., Wang, Y., Xiao, L., & Li, L. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.913749 · Cited by 19 · see citing works
Goichot, B., Raverot, V., Klein, M., Racaru, L. V., Payrat, J. A.-D., Lairez, O., Leroy, R., Cailleux, A., Wolff, P., Groussin, L., et al. (2020) · Annales d Endocrinologie · doi:10.1016/j.ando.2020.04.010 · Cited by 18 · see citing works
Giuffrida, G., Bagnato, G., Campennì, A., Giovinazzo, S., Keller, K. P., Alibrandi, A., Roberts, W. N., Trimarchi, F., & Ruggeri, R. M. (2019) · Journal of Endocrinological Investigation · doi:10.1007/s40618-019-01083-w · Cited by 18 · see citing works
Xie, J., Wang, X., Zhang, Y., Li, H., Xu, Y., & Zheng, D. (2019) · BMC Endocrine Disorders · doi:10.1186/s12902-019-0405-0 · Cited by 16 · see citing works
Stratigou, T., Muscogiuri, G., Kotopouli, M., Antonakos, G., Christodoulatos, G. S., Karampela, Ι., Μαρίνου, Ι., Tsilingiris, D., Vallianou, N. G., Vogiatzakis, E., et al. (2022) · Panminerva Medica · doi:10.23736/s0031-0808.22.04701-2 · Cited by 12 · see citing works
Fenneman, A. C., Rampanelli, E., van der Spek, A. H., Fliers, E., & Nieuwdorp, M. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-073971 · Cited by 11 · see citing works
Subclinical hypothyroidism: new trials, old caveats
Lamine, F., Giorgi, S. D., Marino, L., Michalaki, M. A., & Sykiotis, G. P. (2018) · HORMONES · doi:10.1007/s42000-018-0004-x · Cited by 10 · see citing works
Lai, R., Deng, X., Lv, X., Liu, Q., Zhou, K., & Peng, D. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1256208 · Cited by 9 · see citing works
Chu, M., Cai, Y., Zhong, J., Qian, Y., Yan, C., Dou, M., Chen, G., Sun, B., & Lu, X. (2021) · Quantitative Imaging in Medicine and Surgery · doi:10.21037/qims-21-190 · Cited by 8 · see citing works
Xu, Y., Peng, H., Su, G., Cheng, Y., Guo, Q., Guo, L., Peng, X., & Ke, J.-F. (2023) · Radiation Oncology · doi:10.1186/s13014-023-02329-x · Cited by 6 · see citing works
Hypothalamic control of heart rate and body temperature by thyroid hormones
Mittag, J., & Kolms, B. (2025) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-025-09966-5 · Cited by 5 · see citing works
Can Hypothyroidism Cause Acute Central Serous Chorioretinopathy?
Ulaş, F., Uyar, E., Tekçe, H., & Çelebi, S. (2019) · Seminars in Ophthalmology · doi:10.1080/08820538.2019.1684524 · Cited by 5 · see citing works
Effects of Shuganjianpihuatanxingqi decoction on mild subclinical hypothyroidism
Bai, L., Zhao, J., Gao, J., Li, F., Wei, F., Li, J., Xiao, Y., Han, X., Wang, Y., Wang, D., et al. (2018) · Medicine · doi:10.1097/md.0000000000013183 · Cited by 5 · see citing works
Chacon, M. M., & Markin, N. W. (2018) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2018.12.017 · Cited by 4 · see citing works
Nock, S., Höfig, C. S., Harder, L., Schomburg, L., Brabant, G. E., & Mittag, J. (2019) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/a-1012-8484 · Cited by 4 · see citing works
Instability of harmonized thyroid‐stimulating hormone immunoassays in clinical practice
Uto, K., Bando, H., Fukuoka, H., Yamamoto, M., Ogasahara, A., Ono, S., Oyabu, C., Sato, I., Imanishi, T., Saegusa, J., et al. (2023) · Clinical Endocrinology · doi:10.1111/cen.14938 · Cited by 2 · see citing works
Freitas, C., Rodrigues, F., Rocha, G., Simões, H., Miguel, M., & Azevedo, T. (1999) · Revista Portuguesa de Endocrinologia Diabetes e Metabolismo · doi:10.26497/na190056 · Cited by 2 · see citing works
The Relationship and Research Progress be-tween Subclinical Thyroid Dysfunction and Osteoporosis
杨, 贤. (2023) · Advances in Clinical Medicine · doi:10.12677/acm.2023.1361416 · Cited by 1 · see citing works
Marouli, E., Kuś, A., Fabiola Del Greco, M., Chaker, L., Peeters, R. P., Teumer, A., Deloukas, P., & Medici, M. (2019) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/718429
Self-citationGarla, V. V., Cardozo, L. L. Y., & Lien, L. F. (2018) · Springer eBooks · doi:10.1007/978-3-319-99079-8_2
Mudassar, S., Ali, M., Mahmood, F., Bashir, F., Ahmed, S., Mubeen, A., & Shaukat, A. (2022) · Pakistan Journal of Medical and Health Sciences · doi:10.53350/pjmhs22163218
Évaluation biologique de la fonction thyroïdienne
Raverot, V., & d’Herbomez, M. (2022) · Elsevier eBooks · doi:10.1016/b978-2-294-77583-3.00003-4
Characteristics and Dynamics of Thyroid Dysfunction in the Bulgarian Population - Screening 2024
Borissova, A.-M., Trifonova, B., Dakovska, L. N., & Vukov, M. I. (2025) · Clinical Medicine Research · doi:10.11648/j.cmr.20251403.14
- Authors
- Peeters, R. P.
- Affiliations
- Erasmus MC (NL)
- Corresponding author
- Robin Patrick Peeters
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2017-10-05
- Volume
- 377
- Issue
- 14
- Pages
- 1404-1404
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W3084404916
- Cited by
- 36
- References
- 10
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 7 · 2022: 4 · 2021: 3 · 2020: 4 · 2019: 8 · 2018: 6
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- subclinical hypothyroidism, thyroid ultrasound, thyroid autoimmunity, incidental finding, thyroid cancer incidence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
