Subclinical hypothyroidism: the case for treatment

Owen, Penny; Lazarus, John H.

doi:10.1016/s1043-2760(03)00108-5

Cited by 40 publications

(23 citation statements)

References 53 publications

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“…Subclinical hypothyroidism causes increased cardiovascular risk (25). A recent study from Klose et al (26) showed that high levels of serum free T4 in the upper normal range was correlated to a lower body mass index (BMI) and lower levels of high density lipoprotein cholesterol.…”

Section: Hypopituitarismmentioning

confidence: 99%

Endocrine aspects and sequel in patients with craniopharyngioma

Erfurth

2015

Journal of Pediatric Endocrinology and Metabolism

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A craniopharyngioma (CP) is an embryonic malformation of the sellar and parasellar region. The annual incidence is 0.5-2.0 cases/million per year and approximately 60% of CP is seen in adulthood. The therapy of choice is surgery, followed by cranial radiotherapy in about half of the patients. Typical initial manifestations at diagnosis in children are symptoms of elevated intracranial pressure, visual disturbances and hypopituitarism. CPs have the highest mortality of all pituitary tumours. The standardised overall mortality rate varies from 2.88 to 9.28 in cohort studies. Adults with CP have a 3-19-fold higher cardiovascular mortality in comparison to the general population. Women with CP have an even higher risk. The long-term morbidity is substantial with hypopituitarism, increased cardiovascular risk, hypothalamic damage, visual and neurological deficits, reduced bone health and reduction in quality of life and cognitive function.

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Section: Hypopituitarismmentioning

confidence: 99%

Endocrine aspects and sequel in patients with craniopharyngioma

Erfurth

2015

Journal of Pediatric Endocrinology and Metabolism

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“…It has been, and still is, much debated whether the abnormality should be treated with levothyroxine (L-T 4 ) or not (19)(20)(21)(22)(23)(24). Biondi & Cooper (25) have authored an exhaustive review on the aetiology, epidemiology and consequences of SCH and on treatment effects on SCH.…”

Section: Introductionmentioning

confidence: 99%

Variation in thyroid function in subclinical hypothyroidism: importance of clinical follow-up and therapy

Karmisholt

Andersen

Laurberg

2011

European Journal of Endocrinology

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Subclinical hypothyroidism (SCH) is a common condition that is often observed without therapy. However, no evidence-based recommendation exists with regards to how patients with untreated SCH should be monitored. Monitoring involves regular assessment of symptoms and signs of hypothyroidism (HYPO) and biochemical tests of thyroid function. An important question when repeated tests of thyroid function are performed is how large a difference in test results is needed to be confident that the change is real and not just due to chance variation. Recent data show that the least significant difference between two tests in SCH is 40% for TSH and 15% for free thyroxine and free triiodothyronine, with 90% confidence. Furthermore, monitoring has to be based on biochemical function testing because serial evaluation of symptoms and signs related to HYPO is rather insensitive in detecting worsening of thyroid insufficiency. When the presence of thyroid peroxidase auto-antibodies (TPO-Ab) in serum has been demonstrated, repeated measurements do not add much useful information in the monitoring of individual subclinical hypothyroid patients, as levels of TPO-Ab vary in parallel with TSH in these patients. Lastly, we discuss how differences in the monitoring procedure influence the diagnostic outcome, and we suggest a follow-up approach for untreated subclinical hypothyroid patients.

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“…5 Accordingly, it would be of interest to examine the relation between blood pressure and thyroid function even in euthyroid subjects. This could be of potential importance in the discussion on whether to treat subjects with subclinical hypothyroidism, 6,7 as well as when discussing what should be considered the upper 'normal' thyrotropin (TSH) level.…”

Section: Introductionmentioning

confidence: 99%

Blood pressure in relation to serum thyrotropin: the Tromsø study

2006

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It appears to be an association between hypothyroidism and hypertension. However, the relation between thyroid function and blood pressure within the normal serum thyrotropin (TSH) range is uncertain. In the fifth Tromsø study, which is a population-based health survey, serum TSH and blood pressure were measured. This gave us the opportunity to test the hypothesis of a relation between serum TSH and blood pressure within the normal serum TSH range. In all 5872 subjects (2623 male subjects) not using blood pressure or thyroxine medication were included in the present study. Within the normal serum TSH range (0.20-4.00 mIU/l), there was a significant and positive relation between serum TSH and both systolic and diastolic blood pressure. Within this range, and adjusted for age, body mass index and smoking status, the systolic blood pressure was 1.4 mm Hg and the diastolic 1.6 mm Hg higher in male subjects in the highest versus those in the lowest serum TSH quartile. The corresponding differences in the female subjects were 4.0 and 2.7 mm Hg, respectively. When dividing this cohort in those with systolic (4160 mm Hg) and diastolic (495 mm Hg) hypertension, serum TSH was higher in the hypertensive subjects, but the differences were only statistically significant for diastolic hypertension (serum TSH 1.8870.82 versus 1.6970.74 mIU/l for male subjects, and 1.7970.78 versus 1.6370.75 mIU/l for female subjects, Po0.05). In conclusion, there is a modest, but significant positive association between serum TSH and blood pressure within the normal serum TSH range.

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Subclinical hypothyroidism: the case for treatment

Cited by 40 publications

References 53 publications

Endocrine aspects and sequel in patients with craniopharyngioma

Endocrine aspects and sequel in patients with craniopharyngioma

Variation in thyroid function in subclinical hypothyroidism: importance of clinical follow-up and therapy

Blood pressure in relation to serum thyrotropin: the Tromsø study

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