Subclinical thyrotoxicosis in an outpatient population - predictors of outcome: Subclinical thyrotoxicosis - predictors of outcome
Abstract
OBJECTIVE: Individuals with endogenous subclinical thyrotoxicosis (SCT) may subsequently require treatment for overt disease. We aimed to evaluate the frequency of progression to hyperthyroidism and factors influencing this outcome. DESIGN: This is a retrospective analysis of outcome in 96 consecutive patients (aged 16-91 years) diagnosed with SCT over a 6-year period. Individuals with secondary causes of TSH suppression were excluded. Mean follow-up was 3·8 years. The significance of age, gender, family history of thyrotoxicosis, symptoms at presentation, thyroid nodule(s) on clinical examination, entry TSH level, antithyroid antibody status and (99m) Tc pertechnetate thyroid imaging results on subsequent development of overt thyrotoxicosis was assessed. RESULTS: Progression to overt thyrotoxicosis was seen in 8% at 1 year, 16% at 2 years, 21% at 3 years and 26% at 5 years. Multivariate analysis determined that diagnosis as determined by scintiscan to be the only independent predictor of outcome (P = 0·003) with the cumulative percentage requiring therapy at 5 years being 9% for subclinical Graves' disease, 21% for multinodular goitre and 61% for the autonomous nodule subgroup. CONCLUSIONS: Progression of SCT to overt hyperthyroidism occurred at a rate of 5-8% per year with disease aetiology, as determined by thyroid scintigraphy, significantly influencing risk of progression.
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5-8% of grade 2 subclinical hyperthyroidism patients may progress to overt disease each year.
“In contrast, 5-8% of grade 2 SHyper patients may progress to overt disease each year [35,36] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [35]
Similar rates have been reported in studies from Europe, with higher levels in women and older subjects.
“Similar rates have been reported in studies from Europe, with higher levels in women and older subjects (366,367).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [367]
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 [367]
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 [367]
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 [367]
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- Authors
- Schouten, B. J., Brownlie, B. E. W., Frampton, C. M., & Turner, J. G.
- Affiliations
- Christchurch Hospital (NZ)
- University of Otago (NZ)
- Corresponding author
- Schouten, Belinda J.
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2011-01-06
- Volume
- 74
- Issue
- 2
- Pages
- 257-261
- ISSN
- 0300-0664 (ISSN-L)
- OpenAlex
- W1550642760
- Cited by
- 55
- References
- 27
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 3 · 2020: 2 · 2019: 3 · 2018: 6 · 2017: 1 · 2016: 6 · 2015: 3 · 2014: 2 · 2013: 5 · 2012: 5
- FWCI
- 4.34
- Type
- journal article
- Language
- en
- Open access
- closed
- 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 thyrotoxicosis, multinodular goiter, autonomously functioning thyroid nodules, thyroid scintigraphy, thyroid autoantibodies, TSH suppression, risk factors, etiology
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Hyperthyroidism, Male, Middle Aged, Thyrotoxicosis, Kaplan-Meier Estimate
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