Subclinical hyperthyroidism: clinical features and treatment options

Biondi, Bernadette; Palmieri, Emiliano Antonio; Klain, Michele; Schlumberger, Martin; Filetti, Sebastiano; Lombardi, Gaetano

doi:10.1530/eje.1.01809

Cited by 217Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryThyroid Cancer Diagnosis and Treatment

Subclinical hyperthyroidism: clinical features and treatment options

Biondi, Bernadette, Palmieri, Emiliano Antonio, Klain, Michele, Schlumberger, Martin, Filetti, Sebastiano, Lombardi, Gaetano·2005·European Journal of Endocrinology

DOI 10.1530/eje.1.01809

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Abstract

Subclinical hyperthyroidism appears to be a common disorder. It may be caused by exogenous or endogenous factors: excessive TSH suppressive therapy with l -thyroxine ( l -T4) for benign thyroid nodular disease, differentiated thyroid cancer, or hormone over-replacement in patients with hypothyroidism are the most frequent causes. Consistent evidence indicates that ‘subclinical’ hyperthyroidism reduces the quality of life, affecting both the psycho and somatic components of well-being, and produces relevant signs and symptoms of excessive thyroid hormone action, often mimicking adrenergic overactivity. Subclinical hyperthyroidism exerts many significant effects on the cardiovascular system; it is usually associated with a higher heart rate and a higher risk of supra-ventricular arrhythmias, and with an increased left ventricular mass, often accompanied by an impaired diastolic function and sometimes by a reduced systolic performance on effort and decreased exercise tolerance. It is well known that these abnormalities usually precede the onset of a more severe cardiovascular disease, thus potentially contributing to the increased cardiovascular morbidity and mortality observed in these patients. In addition, it is becoming increasingly apparent that subclinical hyperthyroidism may accelerate the development of osteoporosis and hence increased bone vulnerability to trauma, particularly in postmenopausal women with a pre-existing predisposition. Subclinical hyperthyroidism and its related clinical manifestations are reversible and may be prevented by timely treatment.

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Suppression of TSH may be iatrogenic due to thyroid hormone overtreatment, either intentionally, unintentionally, or surreptitiously.
“Suppression of TSH may also be iatrogenic (exogenous) due to thyroid hormone overtreatment, either intentionally (in patients with thyroid cancer), unintentionally (in patients with hypothyroidism) or surreptitiously [2,3] ( table 1 ).”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [2]

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1996, Journal of Clinical Endocrinology & Metabolism, 56, 283
STOTT, 1991, QJM, 78, 77
Drinka, 1999, Geriatrics, 54, 58
1977, Endocrinology and metabolism clinics of North America, 26, 189
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Biondi, 1999, Cardiologia (Rome, Italy), 44, 443
Biondi, 1998, Journal of Clinical Endocrinology & Metabolism, 83, 2643, 10.1210/jc.83.8.2643 · DOI
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1988, Circulation, 98, 946
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Biondi, 1996, Journal of Clinical Endocrinology & Metabolism, 81, 4224, 10.1210/jc.81.12.4224 · DOI
Rosen, 1992, Journal of Clinical Endocrinology & Metabolism, 75, 1531, 10.1210/jc.75.6.1531 · DOI
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Marcocci, 1994, Journal of Clinical Endocrinology & Metabolism, 78, 818, 10.1210/jc.78.4.818 · DOI
Adlin, 1991, The American journal of medicine, 90, 360, 10.1016/0002-9343(91)80017-g · DOI
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Authors: Biondi, B., Palmieri, E. A., Klain, M., Schlumberger, M., Filetti, S., & Lombardi, G.
Affiliations: Federico II University Hospital (IT)
University of Naples Federico II (IT)
Institut Gustave Roussy (FR)
Corresponding author: Biondi, Bernadette
ORCID: Biondi, Bernadette
Klain, Michele
Schlumberger, Martin
Venue: European Journal of Endocrinology
Publisher: Oxford University Press (OUP)
Published: 2005-01
Volume: 152
Issue: 1
Pages: 1-9
ISSN: 0804-4643 (ISSN-L)
1479-683X
DOI: 10.1530/eje.1.01809
OpenAlex: W2051330706
Cited by: 217
References: 114
Citations by year: 2026: 2 · 2025: 5 · 2024: 6 · 2023: 9 · 2022: 8 · 2021: 2 · 2020: 5 · 2019: 6 · 2018: 7 · 2017: 4 · 2016: 18 · 2015: 8 · 2014: 10 · 2013: 15 · 2012: 15
FWCI: 2.11
Type: journal article
Language: de
Open access: closed
Locations: European Journal of Endocrinology (publishedVersion)
PubMed (publishedVersion)
IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
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, TSH suppression, levothyroxine, thyroid nodules, differentiated thyroid cancer, quality of life, cardiovascular effects, supraventricular arrhythmias, left ventricular hypertrophy, diastolic dysfunction, exercise intolerance, osteoporosis, postmenopausal women, treatment options
MeSH terms: Adrenergic beta-Antagonists, Aged, Cardiovascular Diseases, Female, Humans, Hyperthyroidism, Osteoporosis, Thyrotropin, Thyroxine, Triiodothyronine, Bisoprolol

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Subclinical hyperthyroidism: clinical features and treatment options

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