What is Subclinical Hypothyroidism? It should be treated?

Year 2018, Volume: 44 Issue: 2, 129 - 134, 01.08.2018

Özen Öz Gül , Soner Cander , Canan Ersoy

https://doi.org/10.32708/uutfd.435351

Abstract

Although serum free thyroid hormone levels are normal, high levels of
thyroid stimulating hormone is more frequent condition in population and is
defined as subclinical hypothyroidism. In general population 3-8 % is seen. Prevalance
of subclinical hypothyroidism increases with age and is more common in women.
Most important consequence of subclinical hypothyroidism is progression to
overt hypothyroidism. increased risk of cardiovascular disease and a decreased
cognitive functions due to subclinical hypothyroidism remains uncertain.
Therefore, the consensus about the benefits of levothyroxine treatment is not
available. In general, the level of thyroid stimulating hormone 10 mU/L, those
on treatment are recommended, which are below the level of treatment to be
personalized, consideration of patient age, risk factors are recommended.

Keywords

Subclinical hypothyroidism, thyroid function tests

Subklinik Hipotiroidi Nedir? Tedavi Edilmeli midir?

Abstract

Bireylerin serum
serbest tiroid hormon düzeyleri normal değerlerde iken tiroid uyarıcı hormon
düzeyinin yüksek olması toplumda oldukça sık görülen bir durumdur ve bu durum
subklinik hipotiroidi olarak tanımlanmaktadır. Subklinik hipotiroidi genel
populasyonda %3-8 oranında görülmekte, prevalansı yaşla birlikte artmakta ve
kadınlarda daha sık görülmektedir. Subklinik hipotiroidinin en önemli sonucu
aşikar hipotiroidiye ilerlemedir. Subklinik hipotiroidi ile kardiyovasküler
hastalıklarda artış ve bilişsel fonksiyonlarda azalma arasındaki ilişki kesin
olarak gösterilememiştir. Bu nedenle levotiroksin tedavisinin faydaları
konusunda da fikir birliği bulunmamaktadır. Genel olarak tiroid uyarıcı hormon düzeyi
10 mU/L’nin üzerinde olanlara tedavi önerilmekte, bu düzeylerin altında
olanlarda tedavinin kişiselleştirilmesi, hastaların risk faktörleri ve yaşları
göz önünde bulundurularak değerlendirilmeleri önerilmektedir.

Keywords

Subklinik hipotiroidi, tiroid fonksiyon testleri

References

• 1) Cooper DS. Subclinical hypothyroidism. N Engl J Med. 2001; 345(4): 260-5.
• 2) Türkiye Endokrinoloji ve Metabolizma Derneği, tiroid hastalıkları tanı ve tedavi klavuzu. Subklinik hipotiroidi. 4. Baskı. Tuna matbacılık, Ankara, 2013, 13-15.
• 3) Surks MI, Hollowell JG. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. J Clin Endocrinol Metab. 2007; 92(12): 4575.
• 4) Singer PA, Cooper DS, Levy EG, Ladenson PW, Braverman LE, Daniels G, Greenspan FS, McDougall IR, Nikolai TF. Treatment guidelines for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. 1995; 273: 808-12.
• 5) Baskin HJ, Cobin RH, Duick DS, Gharib H, Guttler RB, Kaplan MM, Segal RL. American Association of Clinical Endocrinologists medical guidelines for clinical practice fort he evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract 2002; 8: 457-69.
• 6) Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT; American Association of Clinical Endocrinologists/American Thyroid Association/Endocrine Society. Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society. Endocr Pract. 2004; 10(6): 497-501.
• 7) Fatourechi V, Klee GG, Grebe SK, Bahn RS, Brennan MD, Hay ID, McIver B, Morris JC 3rd. Effects of reducing the upper limit of normal TSH values. JAMA. 2003; 290(24): 3195-6.
• 8) Vanderpump MP1, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, Grimley Evans J, Hasan DM, Rodgers H, Tunbridge F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995; 43(1): 55-68.
• 9) Hollowell JG1, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002; 87(2): 489-99.
• 10) Canaris GJ1, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med. 2000; 160(4): 526-34.
• 11) Hamburger JI, Meier DA, Szpunar WE. Factitious elevation of thyrotopin in euthyroid patients. N Engl J Med. 1985; 313(4): 267-8.
• 12) Tunbridge WM, Harsoulis P, Goolden AW. Thyroid function in patients treated with radioactive iodine for thyrotoxicosis. Br Med J. 1974; 3(5923): 89-92.
• 13) Türkiye Endokrinoloji ve Metabolizma Derneği, tiroid hastalıkları tanı ve tedavi klavuzu. Tiroiditler. 4.baskı. Tuna matbacılık, Ankara, 2013, 38-44. 14) Clinical guideline, part 1. Screening for thyroid disease. American College of Physicians. Ann Intern Med. 1998; 129(2): 141.
• 14) Clinical guideline, part 1. Screening for thyroid disease. American College of Physicians. Ann Intern Med. 1998; 129(2): 141.
• 15) Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, Pessah-Pollack R, Singer PA, Woeber KA, American Association Of Clinical Endocrinologists And American Thyroid Association Taskforce On Hypothyroidism In Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012; 22(12): 1200.
• 16) Rugge JB, Bougatsos C, Chou R. Screening and treatment of thyroid dysfunction: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015; 162(1): 35.
• 17) Huber G, Staub JJ, Meier C, Mitrache C, Guglielmetti M, Huber P, Braverman LE. Prospective study of the spontaneous course of subclinical hypothyroidism: prognostic value of thyrotropin, thyroid reserve, and thyroid antibodies. J Clin Endocrinol Metab. 2002; 87(7): 3221-6.
• 18) Baumgartner C, Blum MR, Rodondi N. Subclinical hypothyroidism: summary of evidence in 2014. Swiss Med Wkly. 2014; 23: 144: w14058.
• 19) Meyerovitch J, Rotman-Pikielny P, Sherf M, Battat E, Levy Y, Surks MI. Serum thyrotropin measurements in the community: five-year follow-up in a large network of primary care physicians. Arch Intern Med. 2007; 167(14): 1533-8.
• 20) Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witteman JC. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med. 2000; 132(4): 270-8.
• 21) Rodondi N, den Elzen WP, Bauer DC, Cappola AR, Razvi S, Walsh JP, Asvold BO, Iervasi G, Imaizumi M, Collet TH, Bremner A, Maisonneuve P, Sgarbi JA, Khaw KT, Vanderpump MP, Newman AB, Cornuz J, Franklyn JA, Westendorp RG, Vittinghoff E, Gussekloo J; Thyroid Studies Collaboration. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA. 2010; 304(12): 1365-74.
• 22) Gencer B, Collet TH, Virgini V, Bauer DC, Gussekloo J, Cappola AR, Nanchen D, den Elzen WP, Balmer P, Luben RN, Iacoviello M, Triggiani V, Cornuz J, Newman AB, Khaw KT, Jukema JW, Westendorp RG, Vittinghoff E, Aujesky D, Rodondi N; Thyroid Studies Collaboration. Subclinical thyroid dysfunction and the risk of heart failure events: an individual participant data analysis from 6 prospective cohorts. Circulation. 2012; 126(9): 1040-9.
• 23) Stagnaro-Green A, Roman SH, Cobin RH, el-Harazy E, Alvarez-Marfany M, Davies TF. Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies. JAMA. 1990; 264(11): 1422-5.
• 24) Casey BM, Dashe JS, Wells CE, McIntire DD, Byrd W, Leveno KJ, Cunningham FG. Subclinical hypothyroidism and pregnancy outcomes. Obstet Gynecol. 2005; 105(2): 239-45.
• 25) Monzani F, Del Guerra P, Caraccio N, Pruneti CA, Pucci E, Luisi M, Baschieri L. Subclinical hypothyroidism: neurobehavioral features and beneficial effect of L-thyroxine treatment. Clin Investig. 1993; 71(5): 367-71.
• 26) Joffe RT, Levitt AJ. Major depression and subclinical (grade 2) hypothyroidism. Psychoneuroendocrinology. 1992; 17(2-3): 215-21.
• 27) Roberts LM, Pattison H, Roalfe A, Franklyn J, Wilson S, Hobbs FD, et al. Is subclinical thyroid dysfunction in the elderly associated with depression or cognitive dysfunction? Ann Intern Med. 2006; 145(8): 573–81.
• 28) Chung GE, Kim D, Kim W, Yim JY, Park MJ, Kim YJ, Yoon JH, Lee HS. Non-alcoholic fatty liver disease across the spectrum of hypothyroidism. J Hepatol. 2012; 57(1): 150-6.
• 29) Waring AC, Arnold AM, Newman AB, BùzkováP, Hirsch C, Cappola AR. Longitudinal changes in thyroid function in the oldest old and survival: the cardiovascular health study all-stars study. J Clin Endocrinol Metab. 2012; 97(11): 3944-50.
• 30) Fox CS, Pencina MJ, D'Agostino RB, Murabito JM, Seely EW, Pearce EN, Vasan RS. Relations of thyroid function to body weight: cross-sectional and longitudinal observations in a community-based sample. Arch Intern Med. 2008; 168(6): 587-92.
• 31) Manji N, Boelaert K, Sheppard MC, Holder RL, Gough SC, Franklyn JA. Lack of association between serum TSH or free T4 and body mass index in euthyroid subjects. Clin Endocrinol (Oxf). 2006; 64(2): 125-8.
• 32) Tan ZS, Beiser A, Vasan RS, Au R, Auerbach S, Kiel DP, Wolf PA, Seshadri S. Thyroid function and the risk of Alzheimer disease: the Framingham Study. Arch Intern Med. 2008; 168(14): 1514-20.
• 33) Laukkarinen J, Kiudelis G, Lempinen M, Räty S, Pelli H, Sand J, Kemppainen E, Haglund C, Nordback I. Increased prevalence of subclinical hypothyroidism in common bile duct stone patients. J Clin Endocrinol Metab. 2007; 92(11): 4260-4.
• 34) Cinemre H, Bilir C, Gokosmanoglu F, Bahcebasi T. Hematologic effects of levothyroxine in iron-deficient subclinical hypothyroid patients: a randomized, double-blind, controlled study. J Clin Endocrinol Metab. 2009; 94(1): 151-6.
• 35) Jaeschke R, Guyatt G, Gerstein H, Patterson C, Molloy W, Cook D, Harper S, Griffith L, Carbotte R. Does treatment with L-thyroxine influence health status in middle-aged and older adults with subclinical hypothyroidism? J Gen Intern Med. 1996; 11(12): 744-9.
• 36) Mooradian AD. Subclinical hypothyroidism in the elderly: to treat or not to treat? Am J Ther. 2011; 18(6): 477-86.
• 37) Danese MD, Ladenson PW, Meinert CL, Powe NR. Clinical review 115: effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: a quantitative review of the literature. J Clin Endocrinol Metab. 2000; 85(9): 2993-3001.
• 38) Villar HC, Saconato H, Valente O, Atallah AN. Thyroid hormone replacement for subclinical hypothyroidism. Cochrane Database Syst Rev. 2007; 3: CD003419.