Natural history of subclinical hyperthyroidism in elderly patients with TSH between 0·1 and 0·4 mIU/l: a prospective study

Rosario, Pedro Weslley

doi:10.1111/j.1365-2265.2009.03696.x

Cited by 88Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

Natural history of subclinical hyperthyroidism in elderly patients with TSH between 0·1 and 0·4 mIU/l: a prospective study

Rosario, Pedro Weslley·2010·Clinical Endocrinology

DOI 10.1111/j.1365-2265.2009.03696.x

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Abstract

Summary: Context One important aspect in the decision to treat or not elderly patients with subclinical hyperthyroidism (SCH) is the risk of progression to overt hyperthyroidism (OH). Objective To define the natural history of endogenous SCH in elderly patients with TSH between 0·1 and 0·4 mIU/l. Design Prospective study. One hundred and two women aged ≥60 years with persistently low TSH ranging from 0·1 to 0·4 mIU/l and normal free T4 and T3 were studied. Patients using L‐T4 or antithyroid drugs, previously treated for hyperthyroidism, with pituitary disease, using corticosteroids, amiodarone, dopaminergic agonists, with atrial fibrillation or heart disease were excluded. Seven patients had Graves’ disease, 91 had nodular disease and 4 presented no defined cause. The time of follow‐up ranged from 12 to 70 months (median 41 months). Results Three patients progressed to OH (elevated T4 and/or T3) and four other patients to persistently low TSH (<0·1 mIU/l) in the presence of increase in serum T3 when compared with baseline. These patients were treated. Twenty‐four women presented sustained normalization of TSH and none progressed to hypothyroidism. SCH with TSH in the 0·1–0·4 mIU/l range persisted in 71 patients, 4 of them (5·6%) being treated because of the development of atrial fibrillation or heart disease during follow‐up. The only independent predictor of progression of SCH was an initial TSH value <0·2 mIU/l. Conclusions In elderly patients with endogenous SCH and TSH between 0·1 and 0·4 mIU/l progression to clinical hyperthyroidism is uncommon (approximately 1% per year), spontaneous TSH normalization may occur, and persistence of SCH for many years is the most likely.

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Low serum TSH levels may normalize in 25-50% of patients with grade 1 subclinical hyperthyroidism.
“Low serum TSH levels may normalize in 25-50% of patients with grade 1 SHyper, as reported in two prospective studies with a long-term follow-up [33,34] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [33]
Progression from SH to overt hyperthyroidism appears more likely if the TSH is suppressed (<0.01 mU/L), rather than low but detectable (0.01-0.4 mU/L).
“Pro-gression from SH to overt hyperthyroidism appears more likely if the TSH is suppressed (<0.01 mU/L), rather than low but detectable (0.01-0.4 mU/L) (375-377).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [376]
In clinical series, TMNG is the most common cause of SH, especially in older persons.
“In clinical series, TMNG is the most common cause of SH, especially in older persons (367,376,377).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [376]
The natural history of SH is variable, with annualized rates of 0.5%-7% progression to overt hyperthyroidism and 5%-12% reversion to normal TSH levels.
“The natural history of SH is variable (367,370-377), with annualized rates of 0.5%-7% progression to overt hyperthyroidism and 5%-12% reversion to normal TSH levels.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [376]
Some patients with subclinical hyperthyroidism due to Graves' disease may remit spontaneously without therapy.
“Some patients with SH due to GD may remit spontaneously without therapy (375-377), so that continued observation without therapy is reasonable for younger patients with SH due to GD.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [376]

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Authors: Rosario, P. W.
Venue: Clinical Endocrinology
Publisher: Wiley
Published: 2010-03-25
Volume: 72
Issue: 5
Pages: 685-688
ISSN: 0300-0664 (ISSN-L)
1365-2265
DOI: 10.1111/j.1365-2265.2009.03696.x
OpenAlex: W2085643661
Cited by: 88
References: 26
Citations by year: 2026: 1 · 2025: 2 · 2024: 3 · 2023: 2 · 2022: 3 · 2021: 2 · 2020: 6 · 2019: 5 · 2018: 10 · 2017: 9 · 2016: 4 · 2015: 5 · 2014: 3 · 2013: 8 · 2012: 13
FWCI: 7.74
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Clinical Endocrinology (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, natural history (disease), older women, thyroid-stimulating hormone, TSH normalization, hypothyroidism, atrial fibrillation, heart disease, thyroid nodules, Graves' disease, prognostic factors
MeSH terms: Aged, Female, Follow-Up Studies, Humans, Hyperthyroidism, Middle Aged, Predictive Value of Tests, Prospective Studies, Reference Values, Risk Factors, Thyrotropin, Thyroxine, Triiodothyronine, Disease Progression

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Natural history of subclinical hyperthyroidism in elderly patients with TSH between 0·1 and 0·4 mIU/l: a prospective study

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