The management of subclinical hyperthyroidism by thyroid specialists

• Published in: Thyroid (New York, N.Y.) Vol. 13; no. 12; p. 1133
• Main Authors: McDermott, Michael T, Woodmansee, Whitney W, Haugen, Bryan R, Smart, Alexandra, Ridgway, E Chester
• Format: Journal Article
• Language: English
• Published: United States 01.12.2003
• Subjects: Antithyroid Agents - therapeutic use; Endocrinology - methods; Endocrinology - statistics & numerical data; Female; Graves Disease - complications; Humans; Hyperthyroidism - blood; Hyperthyroidism - diagnosis; Hyperthyroidism - etiology; Hyperthyroidism - therapy; Iodine Radioisotopes - therapeutic use; Male; Professional Practice - statistics & numerical data; Surveys and Questionnaires; Thyroid Nodule - complications; Thyrotropin - blood
• ISSN: 1050-7256
• DOI: 10.1089/10507250360731532

Subclinical hyperthyroidism is a relatively common condition for which prospectively derived evidenced-based management guidelines do not exist. We have conducted a case-based mail survey to solicit opinions from members of the American Thyroid Association (ATA) about various issues that arise in the management of patients with this disorder. The survey was completed and returned by 185 of 300 (62%) of the original survey recipients. Four hypothetical cases varying in age, thyrotropin (TSH) level and underlying etiology were presented. The majority of respondents recommended further evaluation of all cases, most commonly choosing a radioactive iodine uptake (42%-71%), thyroid scan (39%-68%) and antithyroid (TPO/Tg) antibodies (49%-55%) as the additional tests to be ordered. The large majority (84%) recommended observation rather than active treatment for a young patient with a low but detectable serum TSH level. A small majority also recommended observation alone for a young woman with an undetectable serum TSH level (58%) and for an older woman with a low but detectable serum TSH value (63%). However, the majority (66%) favored treating an older woman with an undetectable serum TSH. When treatment was advised in the patients with subclinical hyperthyroidism, the respondents strongly favored anti-thyroid drugs when the etiology was Graves' disease and radioactive iodine when the etiology was toxic nodular thyroid disease. In the absence of adequate evidence-based guidelines, it is hoped that this survey of expert opinions may provide useful guidance for physicians providing care for patients with subclinical hyperthyroidism.