Subclinical hyperthyroidism
Abstract
Persons with subclinical hyperthyroidism are at increased risk for cardiovascular and skeletal conditions. Decisions regarding treatment depend on age, menopausal status in women, and the presence of symptoms of and risk factors for cardiovascular disease or bone loss.
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LT4 over-treated patients are exposed to chronic excess iodothyronines in sensitive target tissues, mainly heart and bones.
“LT4 over-treated patients are exposed to a chronic state of excess iodothyronines in the more sensitive target tissues, mainly the heart and bones (5)”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [5]
Analyses of real-world data from patient registries have demonstrated that serum TSH levels outside reference intervals in LT4-treated hypothyroidism are associated with adverse health outcomes, including ischemic heart disease events, cardiac dysrhythmias, fractures, and heart failure.
“Analyses of real-world data from patient registries have demonstrated that the levels of serum TSH outside the reference intervals, in patients with LT4-treated hypothyroidism, are associated with adverse health outcomes, including ischemic heart disease events, cardiac dysrhythmias, fractures, and heart failure (5, 72, 73).”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [5]
These risks were particularly more pronounced in those with serum TSH levels consistently at extremes (<0.1 or >10.0 mU/L).
“These risks were particularly more pronounced in those with serum TSH levels that are consistently at the extremes (<0.1 or >10.0 mU/L).”
From ETA guidelines for the use of levothyroxine sodium preparations in monotherapy to optimize the treatment of hypothyroidism (2025) · cites this paper as [5]
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- Authors
- Biondi, B., & Cooper, D. S.
- Affiliations
- Johns Hopkins University (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2018-06-21
- Volume
- 378
- Issue
- 25
- Pages
- 2411-2419
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W4246335980
- Semantic Scholar
- d89d164d3bdb8cfd7d1e88a1593ecc89aec5dbe3
- Cited by
- 135
- References
- 44
- Citations by year
- 2026: 7 · 2025: 14 · 2024: 18 · 2023: 20 · 2022: 24 · 2021: 20 · 2020: 19 · 2019: 9 · 2018: 3
- FWCI
- 1.96
- 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 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, cardiovascular risk, bone loss, osteoporosis, menopause, treatment decision-making, age, cardiovascular risk factors
- MeSH terms
- Aged, Female, Humans, Hyperthyroidism, Iodine Radioisotopes, Methimazole, Reference Values, Antithyroid Agents, Thyroid Hormones, Thyrotropin, Thyroxine, Disease Progression
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