An Analysis of the Natural Course of Subclinical Hyperthyroidism
Abstract
Background Our aim was to evaluate the incidence rate of overt hyperthyroidism in a cohort of patients with subclinical hyperthyroidism and to assess the potential risk factors for the development of overt thyroid hyperfunction.Methods We performed a retrospective analysis in 75 patients (68 women, mean age 62.2 +/- 14.2 years) with subclinical hyperthyroidism and different grades of serum thyrotropin (TSH) suppression. Incidence rate of overt hyperthyroidism and survival time, ie, time without requiring therapy for overt hyperthyroidism, were studied.Results Thirty-four patients (45.3%) developed overt hyperthyroidism and 15 (20.0%) reverted to normal TSH values. The incidence rate of overt hyperthyroidism was 9.69 cases per 100 patient-year in the whole population and 4.12, 7.41, and 29.63 cases per 100 patient-year in subjects with initial TSH values of 0.30 to 0.49, 0.10 to 0.29, and <0.10 mU/L, respectively. Kaplan-Meier analysis of survival time curves showed that the development of overt thyroid hyperfunction was significantly related to the presence of symptoms of hyperthyroidism (P < 0.05) and low (<0.10 mU/L) TSH concentrations (P < 0.001). A stepwise multivariate Cox regression analysis showed that both symptoms and low TSH values were significant factors for progression to overt thyrotoxicosis.Conclusions TSH concentration is the most powerful predictor in the outcome of patients with subclinical hyperthyroidism. Our results suggest that patients with values under 0.10 mU/L have the highest probability to develop overt thyroid hyperfunction. In patients with TSH values higher than this value, the risk of progression is notably lower.
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The degree of TSH suppression is the best parameter for predicting the progression from subclinical to overt hyperthyroidism.
“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 [31]
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- Authors
- Díez, J. J., & Iglesias, P.
- Affiliations
- Hospital Universitario Ramón y Cajal (ES)
- Hospital General De Segovia (ES)
- Corresponding author
- Díez, Juan J.
- Venue
- The American Journal of the Medical Sciences
- Publisher
- Elsevier BV
- Published
- 2009-04
- Volume
- 337
- Issue
- 4
- Pages
- 225-232
- ISSN
- 0002-9629 (ISSN-L)
- OpenAlex
- W1988454911
- Cited by
- 45
- References
- 33
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 1 · 2018: 3 · 2017: 1 · 2016: 1 · 2015: 2 · 2014: 3 · 2013: 3 · 2012: 9
- FWCI
- 5.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of the Medical Sciences (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, overt hyperthyroidism, TSH suppression, risk factors, incidence, natural history (disease)
- MeSH terms
- Aged, Female, Humans, Hyperthyroidism, Male, Middle Aged, Retrospective Studies, Risk Factors, Thyroid Gland, Thyrotropin, Thyroxine, Triiodothyronine, Proportional Hazards Models, Disease Progression, Kaplan-Meier Estimate
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