Serum thyrotrophin at baseline predicts the natural course of subclinical hyperthyroidism
Abstract
Summary: Objective: Optimal therapeutic strategies for subclinical hyperthyroidism are undecided. Overt disease develops in a minority of cases, but the risk factors for progression remain unclear. We examined whether a baseline thyrotrophin (TSH) predicted progression to overt hyperthyroidism in asymptomatic individuals with subclinical hyperthyroidism. Design, patients and measurements: This was a retrospective study of 323 patients with subclinical hyperthyroidism seen in our institution from 2003 to 2010 (mean age 71 years, males 26·9%, females 73·1%, mean follow‐up duration 32 months, range 6–93 months). Serum TSH and free thyroxine (FT 4) were documented at baseline and during follow‐up. After excluding individuals with nonthyroid causes of low TSH, patients were grouped according to initial TSH as: TSH 0·10–0·39 mU/l (grade I) and TSH < 0·10 mU/l (grade II). Results: Only 38 patients (11·8%) developed overt hyperthyroidism with annual progression rates of 0·6–3·7%. Most patients reverted to normal thyroid status (31·6%) or remained subclinically hyperthyroid (56·7%). Progression to frank hyperthyroidism was higher in grade II than in grade I patients (20·3% vs 6·8%, P < 0·001, C hi square test). K aplan–M eier curves showed faster progression rates in grade II than grade I (P < 0·001, log rank test). In stepwise multivariate C ox regression analysis, TSH < 0·1 mU/l was associated with overt hyperthyroidism (hazard ratio 3·4, confidence interval 1·6–7·0), whereas age, gender, FT 4 and aetiological diagnosis were not associated with hyperthyroidism. Conclusions: Thyrotrophin predicts overt hyperthyroidism in asymptomatic individuals with subclinical hyperthyroidism. Patients with TSH < 0·10 mU/l have a higher risk of progressing to hyperthyroidism than those with TSH 0·10–0·39 mU/l.
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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 [377]
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 [377]
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 [377]
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 [377]
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- Authors
- Das, G., Ojewuyi, T. A., Baglioni, P., Geen, J., Premawardhana, L. D., & Okosieme, O. E.
- Affiliations
- Department of Endocrinology and Diabetes Prince Charles Hospital Cwm Taf Local Health Board
- Prince Charles Hospital (GB)
- Cardiff University (GB)
- Corresponding author
- Okosieme, O. E.
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2012-06-06
- Volume
- 77
- Issue
- 1
- Pages
- 146-151
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- OpenAlex
- W2108071280
- Cited by
- 61
- References
- 25
- Citations by year
- 2025: 5 · 2024: 7 · 2023: 3 · 2022: 6 · 2021: 5 · 2020: 7 · 2019: 4 · 2018: 3 · 2017: 4 · 2016: 5 · 2015: 4 · 2014: 2 · 2013: 2 · 2012: 3
- FWCI
- 2.82
- 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 hyperthyroidism, thyroid-stimulating hormone, overt hyperthyroidism, disease progression, prognostic factors, free thyroxine, low TSH, thyroid function
- MeSH terms
- Adult, Aged, Aged, 80 and over, Basal Metabolism, Female, Follow-Up Studies, Humans, Hyperthyroidism, Male, Middle Aged, Prognosis, Retrospective Studies, Thyroid Function Tests, Thyrotropin, Disease Progression, Asymptomatic Diseases
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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