Sterling Pc

Subclinical Hyperthyroidism Cheryl P. Sterling, MD, MPH VCU/MCV Hospitals February 20, 2003

Case Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object]

Case Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical Question ,[object Object],[object Object]

The Thyroid ,[object Object],[object Object],[object Object],[object Object]

Common Signs/Symptoms ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Subclinical Hyperthyroidism Goiter Exophthalmos

Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Shrier, D.K., Burman, K.D. American Family Physician , 2002; 65(3). Biondi, B., et al. Journal of Clinical Endocrinology and Metabolism , 2000; 85(12):4701-4705.

Biochemical Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ladneson, et al. Arch Intern Med , 2000; 160: 1573-1575. Supit, et al. South Med J , 2002; 95(5):481-485.

Diagnostic Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Diagram of thyroid testing www.medscape.com/viewarticle/433852

Evidence-based Research? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Toft, A.D. New England Journal of Medicine , 2001; 345(7):512–516. Shrier, D.K., Burman, K.D. American Family Physician , 2002; 65(3).

Short/Long-term Effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Biondi, B., et al. Journal of Clinical Endocrinology and Metabolism , 2000; 85(12):4701-4705. Shrier, D.K., Burman, K.D. American Family Physician , 2002; 65(3).

Adverse Effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Biondi, B., et al. Journal of Clinical Endocrinology and Metabolism , 2000; 85(12):4701-4705. Kalmijn, S., Mehta, K.M., et al. Clinical Endocrinology (Oxf) , 2000; 53: 733-737.

Journal Article ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sawin, C.T., Geller, A., et al. New England Journal of Medicine , 1994; 331(19): 1249-1252.

Results Sawin, C.T., Geller, A., et al. New England Journal of Medicine , 1994; 331(19): 1249-1252.

Journal Article ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Biondi, B., et al. Journal of Clinical Endocrinology and Metabolism , 2000; 85(12):4701-4705.

Results Biondi, B., et al. Journal of Clinical Endocrinology and Metabolism , 2000; 85(12):4701-4705. ,[object Object],[object Object],[object Object],[object Object]

Conclusions ,[object Object],[object Object],[object Object],Biondi, B., et al. Journal of Clinical Endocrinology and Metabolism , 2000; 85(12):4701-4705.

Subclinical Hyperthyroidism Prevention of atrial fibrillation and osteoporosis are the main potential benefits of treating subclinical hyperthyroidism. Treatment options include: - Beta-blockers - Antithyroid medications - Radioactive iodine ( 131 I) - Surgery - Close clinical follow-up

Subclinical Hyperthyroidism ,[object Object],[object Object],[object Object],[object Object],Toft, A.D. New England Journal of Medicine , 2001; 345(7):512–516. Ladneson, et al. Arch Intern Med , 2000; 160: 1573-1575. Helfand, M., Redfern, C.C. Annals of Internal Medicine , 15 July 1998. 129:141-143, 144-158.

Subclinical Hyperthyroidism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Shrier, D.K., Burman, K.D. American Family Physician , 2002; 65(3).

The Answer (To My Clinical Question) ,[object Object],[object Object],[object Object],[object Object],[object Object]

References Biondi, B., Palmieri, E.A., Fazio, S., et al. Endogenous Subclinical Hyperthyroidism Affects Quality of Life and Cardiac Morphology and Function in Young and Middle-Aged Patients. Journal of Clinical Endocrinology and Metabolism , 2000; 85(12):4701-4705. Helfand, M., Redfern, C.C. Screening for Thyroid Disease: An Update (Parts 1 & 2). Annals of Internal Medicine , 15 July 1998. 129:141-143, 144-158. Kalmijn, S., Mehta, K.M., Pols, H.A.P., Hofman, A., et al. Subclinical hyperthyroidism and the risk of dementia. The Rotterdam Study. Clinical Endocrinology (Oxf) , 2000; 53: 733-737. Ladneson, et al. ATA guidelines for Detection of Thyroid Dysfunction. Archives of Internal Medicine , 2000; 160: 1573-1575. Sawin, C.T., Geller, A., Wolf, P.A., Belanger, A.J., et al. Low Serum Thyrotropin Concentrations as a Risk Factor for Atrial Fibrillation in Older Persons. New England Journal of Medicine , 1994; 331(19): 1249-1252.

References Shrier, D.K., Burman, K.D. Subclinical Hyperthyroidism: Controversies in Management. American Family Physician , 2002; 65(3). Supit, et al. Interpretation of Laboratory Thyroid Function Tests for the Primary Care Physician. Southern Medical Journal , 2002; 95(5):481-485. Toft, A.D. Subclinical hyperthyroidism. New England Journal of Medicine , 2001; 345(7):512–516. Utiger, R.D. Subclinical Hyperthyroidism – Just a Low Serum Thyrotropin Concentration, or Something More? New England Journal of Medicine , 1994; 331(19): 1302-1303.

Sterling Pc

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