Observations Concerning the Natural History of Subclinical Hyperthyroidism
Abstract
OBJECTIVE: To examine the natural history of a subnormal serum thyroid-stimulating hormone (TSH) concentration with normal concentrations of both serum free thyroxine (FT4) and free triiodothyronine (FT3) (subclinical hyperthyroidism). PATIENTS, DESIGN, AND MEASUREMENTS: A retrospective analysis was undertaken and yielded 16 ambulatory patients who had presented with subclinical hyperthyroidism and were longitudinally followed with measurements of serum TSH and both FT4 and FT3 for a cumulative follow-up of 11 to 36 months. Seven of the patients had subclinical Graves' hyperthyroidism as judged from the presence of thyroid-stimulating immunoglobulins (TSI) in serum, and 9 had multinodular goiter confirmed with ultrasound and no TSI. RESULTS: In the 7 patients with TSI, serum TSH reverted to normal in 5 patients, with disappearance or decrease of TSI in 4, within 3 to 19 months. In 1 patient, subnormal serum TSH accompanied by both normal FT4 and FT3 has persisted for 15 months, and in a second patient serum TSH reverted to normal within 9 months, but at follow-up 27 months later overt hyperthyroidism had emerged. In the 9 patients with multinodular goiter, subnormal serum TSH accompanied by both normal FT4 and FT3 persisted during cumulative follow-up that ranged from 11 to 36 months. CONCLUSIONS: This study suggests that the natural history of subclinical hyperthyroidism is variable, resolving or occasionally evolving in subclinical Graves' disease and persisting unchanged in multinodular goiter.
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Patients with Graves' disease are more likely to progress to overt disease or to normalize serum TSH rather than having persistent subclinical hyperthyroidism.
“Patients with GD are more likely to progress to overt disease or to normalize serum TSH rather than having persistent SHyper [38,39] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [38]
The course of subclinical hyperthyroidism may be less predictable in patients with Graves' disease than in those with multinodular goitre.
“The course of the disease may be less predictable in patients with GD than in those with MNG [38] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [38]
Patients with multinodular goitre-associated subclinical hyperthyroidism may have stable thyroid dysfunction over time.
“Patients with MNG-associated SHyper may have stable thyroid dysfunction over time [38,41] , and it is a longterm disease in areas where the natural iodine intake is relatively low.”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [38]
Patients with GD rather than a TMNG as the cause of SH may be more likely to spontaneously remit.
“Patients with GD rather than a TMNG as the cause of SH may be more likely to spontaneously remit (367,378).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [378]
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- Authors
- Woeber, K. A.
- Affiliations
- University of California, San Francisco (US)
- Corresponding author
- Woeber, Kenneth A.
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2005-07
- Volume
- 15
- Issue
- 7
- Pages
- 687-691
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W2072828139
- Cited by
- 59
- References
- 8
- Citations by year
- 2026: 1 · 2024: 1 · 2022: 1 · 2019: 3 · 2018: 1 · 2017: 2 · 2016: 6 · 2015: 2 · 2014: 2 · 2013: 2 · 2012: 4
- FWCI
- 2.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- subclinical hyperthyroidism, natural history (disease), thyroid-stimulating hormone, thyroid-stimulating antibodies, multinodular goiter, free thyroxine, free triiodothyronine, overt hyperthyroidism
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Goiter, Nodular, Graves Disease, Humans, Hyperthyroidism, Male, Middle Aged, Remission, Spontaneous, Retrospective Studies, Severity of Illness Index, Thyrotropin, Thyroxine, Triiodothyronine, Disease Progression
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