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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2006, Number 6

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Rev Invest Clin 2006; 58 (6)

Subclinical thyroid dysfunction. Diagnostic and therapeutic considerations

Cuevas-Ramos D, Pérez-Enríquez B

Language: Spanish
References: 62
Page: 608-616
PDF size: 73.90 Kb.


ABSTRACT

Mild thyroid dysfunction is a biochemical diagnosis classified either as subclinical hypo or hyperthyroidism. It can occur in young patients with a frequency that increases with age, presenting higher morbidity and mortality then. To suspect the diagnosis, it is important to keep in mind some of the nonspecific signs and symptoms of the disease, and the possible laboratory abnormalities. Furthermore, it is advisable to establish an appropriate range of values for thyrotropin (TSH), determine the presence of high risk factors in individuals under evaluation, and the possible consequences on their well-being. Taking into consideration that a non-excesive, adequate hormonal substitution prevents, improves or resolves the harmful effect on different systems of the organism; as well as an early and opportune detection and treatment of mild or subclinical thyroid dysfunction could be beneficial for the general population.


REFERENCES

  1. Helfand M, Redfern CC. Screening for thyroid disease: an update. Ann Intern Med 1998; 129: 144-58.

  2. Ladenson PW, Singer PA, Ain KB, Bagchi N, Bigos ST, Levy EG et al. American Thyroid Association guidelines for detection of thyroid dysfunction. Arch Intern Med 2000; 160: 1573-5.

  3. Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT. CONSENSUS STATEMENT: Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and The Endocrine Society. J Clin Endocrinol Metab 2005; 90: 581-5.

  4. Canaris GJ, Manowitz NR, Mayor G, Ridgway EC. The Colorado thyroid disease prevalence study. Arch Intern Med 2000; 160: 19-27.

  5. Helfand M. Screening for subclinical thyroid dysfunction in nonpregnant adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2004; 140: 128-41.

  6. Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P, et al. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994; 331: 1249-52.

  7. Auer J, Scheibner P, Mische T, et al. Subclinical hyperthyroidism as a risk factor for atrial fibrillation. Am Heart J 2001; 142: 838-42.

  8. Greenspan S, Greenspan F. The effect of thyroid hormone in skeletal integrity. Ann Intern Med 1999; 130: 750-8.

  9. Parle JV, Maisonneuve P, Sheppard MC, Boyle P, Franklyn JA. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year study. Lancet 2001; 358: 861-65.

  10. Hollowell JG, Staehling NW, Hannon WH, Flanders WD, Gunter EW, Spencer CA, et al. Serum thyrotropin, thyroxine and thyroid antibodies in the United States population (1988 to 1994): NHANES III. J Clin Endocrinol Metab 2002; 87: 489-99.

  11. Canaris GJ, Steiner JF, Ridgway EC. Do traditional symptoms of hypothyroidism correlate with biochemical disease? J Gen Intern Med 1997; 12: 544-50.

  12. Vanderpump MPJ, Tunbridge WMG, French JM, Appleton D, Bates D, Rodgers H, et al. The incidence of thyroid disorders in the community; a twenty year follow up of the Whickham survey. Clin Endocrinol 1995; 43: 55-68.

  13. Hak AE, Pols HAP, Visser TJ, Drexhage HA, Hofman A, Witteman JCM. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 2000; 132: 270-78.

  14. Tsimihodimos V, Bairaktari E, Tzallas Ch, Miltiadus G, Liberopoulos E, Elisaf M. The incidence of thyroid function abnormalities in patients attending an outpatient lipid clinic. Thyroid 1999; 9: 365-68.

  15. Michalopoulou G, Alevizaki M, Piperingos G, et al. High serum cholesterol levels in persons with “high-normal” TSH levels: should one extend the definition of subclinical hypothyroidism? Eur J Endocrinol 1998; 138: 141-5.

  16. Streeten HP, Anderson GH Jr, Howland T, et al. Effects of thyroid function on blood pressure: recognition of hypothyroid hypertension. Hypertension 1988; 11: 78-83.

  17. Imaizumi M, Akahoshi M, Ichimaru S, et al. Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism. J Clin Endocrinol Metab 2004; 89: 3365-70.

  18. Kalmijn S, Mehta K, Pols H, Hofman A, Drexhage H, Breteler M. Subclinical hyperthyroidism and the risk of dementia. The Rotterdam Study. Clin Endocrinol 2000; 53: 733-7.

  19. Zophel K, Wunderlich G, Gruning T, Koch R, Doge H, Kotzerke J. Where does subclinical hypothyroidism start? Implications for the definition of the upper reference limit for thyroid stimulating hormone. Nucklearmedizin 2005; 44: 56-61 (Abstract).

  20. Kratzsch J, Fiedler GM, Leichtle A, Brügel M, et al. New reference intervals for thyrotropin and thyroid hormones based on National Academy of Clinical Biochemistry Criteria and regular ultrasonography of the thyroid. Clin Chem 2005; 51: 1480-86.

  21. Biondi B, Palmieri EA, Fazio S, Cosco C, Nocera M, et al. Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients J Clin Endocrinol Metab 2000; 85: 4701–05.

  22. Haddow JE, Palomaki GE, Allan WC, K. G. Williams JR, Gagnon J, O’Heir CE et al. Maternal thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999; 341: 549-55.

  23. Morreale de Escobar, G, Obregon MJ, Escobar del Rey F. Role of thyroid hormone during early brain development. Eur J Endocrinol 2004; 151: 1-14.

  24. Pop VJ, De Vries E, Van Baar AL, Waelkens JJ, De Rooy HA, Horsten M, et al. Maternal thyroid peroxidase antibodies during pregnancy: a marker of impaired child development? J Clin Endocrinol Metab 1995; 80: 3561-66.

  25. Pop VJ, Kuijpens JL, van Baar AL, Verkerk G, van Son MM, de Vijlder JJ, et al. Low maternal free thyroxine concentrations during early pregnancy are associated with impaired psychomotor development in infancy. Clin Endocrinol 1999; 50: 147-48.

  26. Pop VJ, Vulsma T. Maternal hypothyroxinaemia during (early) gestation. Lancet 2005; 365: 1604-06.

  27. Pérez-EB, Kraus A, López G, Cifuentes M, Alarcón-Segovia D. Autoimmune thyroid disease in primary Sjögren’s syndrome. Am J Med 1995; 99: 480-84.

  28. Porkodi R, Ramesh S, Mahesh A, Kanakarani A, Rukmangathrajan S, Panchapakesa C, Rajendran. Thyroid dysfunction in systemic lupus erythematousus and rheumatoid arthritis. J Indian Rheumatol Assoc 2004; 12: 88-90.

  29. Chan ATY, Al Saffar Z, Bucknall RC. Thyroid disease in systemic lupus erythematousus and rheumatoid arthritis. Rheumatology 2001; 40: 353-4.

  30. Cooper DS. Subclinical hypothyroidism. N Engl J Med 2001; 345: 260-5.

  31. Poppe K, Velkeniers B. Female infertility and the thyroid. Best Pract Res Clin Endocrinol Metab 2004; 18: 153-65.

  32. Bjoro T, Holmen J, Kruger O, et al. Prevalence of thyroid disease, thyroid dysfunction and thyroid peroxidase antibodies in a large unselected population: the Health Study of Nord-Trondelag (HUNT). Eur J Endocrinol 2000; 143: 637-39.

  33. Baloch Z, Carayon P, Conte-Devoix B, Demers LM, Feldt-Rasmussen U, Henry JF, et al. Laboratory support for the diagnosis and monitoring of thyroid disease. Thyroid 2003; 13: 3-126.

  34. Gordon DS, Seijeoung K, Nela K, Mary FW, Judylin B, Leon F, Robert AM. Missed hypothyroidism diagnosis uncovered by linking laboratory and pharmacy data. Arch Intern Med 2005; 165: 574-7.

  35. Hueston WJ, Pearson WS. Subclinical hypothyroidism and the risk of hypercholesterolemia. Ann Fam Med 2004; 2: 351-5.

  36. Andersen S, Michael K, Henrik N, Laurberg P. Narrow individual variations in serum T4 and T3 in normal subjects: a clue to the understanding of subclinical thyroid disease. J Clin Endocrinol Metab 2002; 87: 1068-72.

  37. Dayan CM, Ponnusamy S, Graham B. Whose normal thyroid function is better-yours or mine? Commentary in: Lancet 2002: 360; 353-54.

  38. Cooper DS, Halpern R, Wood LC, Levin AA, Ridgway EC. Lthyroxine therapy in subclinical hypothyroidism: a double-blind, placebo-controlled trial. Ann Intern Med 1984; 101: 18-24.

  39. Nystrom E, Caidahl K, Fager G, Wikkelso C, Lundberg P-A, Lindstedt G. A double-blind cross-over 12-month study of L-thyroxine treatment of women with “subclinical” hypothyroidism. Clin Endocrinol 1988; 29: 63-75.

  40. Monzani F, Bello VD, Caraccio N, et al. Effect of levothyroxine on cardiac funcition and structure in subclinical hypothyroidism: a double blind placebo-controlled study. J Clin Endocrinol Metab 2001; 86: 1110-15.

  41. Jaeschke R, Guyatt G, Gerstein H, et al. Does treatment with lthyroxine influence health status in middle-aged and older adults with subclinical hypothyroidism? J Gen Intern Med 1996; 11: 744-49.

  42. Chu JW, Crapo LM. The treatment of subclinical hypothyroidism is seldom necessary. J Clin Endocrinol Metab 2001; 86: 4591-99.

  43. McDermott MT, Ridgway EC. Subclinical hypothyroidism is mild thyroid failure and should be treated. J Clin Endocrinol Metab 2001; 86: 4585-90.

  44. Kong WM, Sheikh M, Lumb P, et al. A 6-month randomized trial of thyroxine treatment in woman with mild subclinical hypothyroidism. Am J Med 2002; 112: 348–54.

  45. Meier C, Roth CB, Huber G, Guglielmetti M, Huber P, Staub JJ. TSH-controlled l-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypothyroidism: a double blind, placebo-controlled trial (Basel Thyroid Study). J Clin Endocrinol Metab 2001, 86; 10: 4860-66.

  46. Nananda FC, Surks MI, Daniels GH. Subclinical thyroid disease. Clinical applications. JAMA 2004; 291: 239-43.

  47. Vanderpump, M. Subclinical hypothyroidism: the case against treatment. Trends Endocrinol Metab 2003; 14: 262-6.

  48. Adler R, de Carvalho GA, Amino N, Aranda C, Baskin JH, Beastall G, et al. Thyrotropin/thyroid stimulating hormone (TSH) measurement. Thyroid 2003; 13: 33-44.

  49. Toft, AD. Thyroxine therapy. N Engl J Med 1994; 331: 174-80.

  50. Papi G, Pearce E, Braverman LE, Betterle C, Roti E. A clinical and therapeutic approach to thyrotoxicosis with thyroid-stimulating hormone suppression only. Am J Med 2005; 118: 349-61.

  51. Gullu S, Altunas F, Dincer I, et al. Effects of TSH suppressive therapy on cardiac morphology and function: benefical effects of the addition of beta-blockade on diastolic dysfunction. Eur J Endocrinol 2004; 150: 665-61.

  52. Kumeda Y, Inaba M, Tahara M, et al. Persistent increase in bone turnover in Graves’ patients with subclinical hyperthyroidism. J Clin Endocrinol Metab 2000; 85: 4157-61.

  53. Bauer DC, Ettinger B, Nevitt MC, Stone KL. Risk for fracture in women with low serum levels of thyroid stimulating hormone. Ann Intern Med 2001; 134: 561-68.

  54. Sgarbi JA, Villaca FG, Garbeline B, Villar HE, Romaldini J. The effects of early antithyroid therapy for endogenous subclinical hyperthyroidism in clinical and heart abnormalities. J Clin Endocrinol Metab 2003; 88: 1672-77.

  55. Surks MI, Ortiz E, Daniels GH, Sawin CT, Nananda FC, et al. Subclinical thyroid disease. Scientific review and guidelines for diagnosis and management. JAMA 2004; 291: 228-38.

  56. Samollow PB, Pérez G, Kammerer CM, Finegold D, et al. Genetic and environmental influences on thyroid hormone variation in mexican americans. J Clin Endocrinol Metab 2004; 89: 3276-84.

  57. Gulias Herrero A, Flores Rebollar A, Cuevas Ramos D. Detección de disfunción tiroidea subclínica en admisiones hospitalarias con la medición de hormona estimulante de tiroides (TSH). Tesis para obtener el título de la especialidad en Medicina Interna por el Dr. Cuevas Ramos. Idea original, tutoría y dirección del Dr. Gulias Herrero. Universidad Nacional Autónoma de México, 2005.

  58. Koltringer P, Eber O, Wakonig P, Klima G, Lind P. Hypothyroidism and the influence on human blood rheology. J Endocrinol Invest 1988; 11: 267-72.

  59. Nedrebo BG, Ericsson UB, Nygard O, Refsum H, Ueland PM, Aakvaag A, et al. Plasma total homocysteine levels in hyperthyroid and hypothyroid patients. Metabolism 1998; 47: 89-93.

  60. Danese MD, Ladenson PW, Meinert CL, Powe NR. 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: 2993-3001.

  61. Iqbal A, Jorde R, Figenschau Y. Serum lipid levels in relation to serum thyroid-stimulating hormone and the effect of thyroxine treatment on serum lipid levels in subjects with subclinical hypothyroidism: the Tromsø Study. J Intern Med 2006; 260: 53-61.

  62. Cooper DS. Subclinical thyroid disease: a clinician’s perspective. Ann Intern Med 1998; 129: 135-38.




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