Endocrinology Book

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Subclinical Hypothyroidism

Aka: Subclinical Hypothyroidism, Sick Euthyroid Syndrome, Euthyroid Sick Syndrome
  1. See Also
    1. Hypothyroidism
  2. Definition
    1. Elevated TSH with normal Free T4
  3. Epidemiology
    1. Incidence Older Men: 2-8%
    2. Incidence Older Women: 5-10%
  4. Indications for treatment
    1. Thyroid Stimulating Hormone (TSH) > 10 mU/ml
    2. Clinical Features present
      1. Depression
      2. Fatigue
      3. Hyperlipidemia
      4. Goiter
      5. Hyperhomocysteinemia
      6. Coronary Artery Disease or Cardiac Risk Factors
      7. Pregnancy or expected pregnancy
  5. Contraindications for treatment
    1. Osteoporosis or Fracture risk
  6. Complications
    1. Coronary Artery Disease (increased risk in elderly)
      1. Biondi (2002) Ann Intern Med
  7. Management
    1. See Hypothyroidism
    2. Levothyroxine
      1. Dosing
        1. Young: start at 50 ug qd
        2. Elderly: start at 12.5 to 25 ug qd
      2. Goals for treating Subclinical Hypothyroidism
        1. LDL Cholesterol falls
        2. Hypothyroidism symptoms improve
        3. TSH normalizes <4.0
  8. Monitoring
    1. Aim to lower Serum TSH to mid-normal: 1-3
  9. Course: Risk of longterm progression to overt Hypothyroidism
    1. TSH 4-6 mU/ml: No increased risk of future Hypothyroidism
    2. TSH >6 mU/ml: 27-42% risk of future Hypothyroidism
    3. TSH >6 mU/ml and Thyroid Peroxidase Antibody positive: >55% risk of future Hypothyroidism
  10. References
    1. Svec (2001) CMEA Medicine Lecture, San Diego
    2. Hueston (2001) Am Fam Physician 64(10):1717-24
    3. Adlin (1998) Am Fam Physician 57(4):776-80
    4. Vanderpump (1995) Clin Endocrinol 43:55

Euthyroid Sick Syndromes (C0015190)

Definition (MSH) Conditions of abnormal THYROID HORMONES release in patients with apparently normal THYROID GLAND during severe systemic illness, physical TRAUMA, and psychiatric disturbances. It can be caused by the loss of endogenous hypothalamic input or by exogenous drug effects. The most common abnormality results in low T3 THYROID HORMONE with progressive decrease in THYROXINE; (T4) and TSH. Elevated T4 with normal T3 may be seen in diseases in which THYROXINE-BINDING GLOBULIN synthesis and release are increased.
Concepts Disease or Syndrome (T047)
MSH D005067
ICD9 790.94
ICD10 E07.81
SnomedCT 237542005
English Euthyroid Sick Syndrome, Euthyroid Sick Syndromes, EUTHYROID SICK SYNDROME <LOW T3/ LOW T4 SYNDROME>, Euthyroid sick syndrome, euthyroid sick syndrome, euthyroid sick syndrome (diagnosis), SICK EUTHYROID SYNDROME, EUTHYROID SICK SYNDROME LOW T3 LOW T4 SYNDROME, Euthyroid sick-syndrome, Euthyroid Sick Syndromes [Disease/Finding], sick euthyroid syndrome, Sick-euthyroid syndrome, Sick-euthyroid syndrome (disorder), sick-euthyroid; syndrome, syndrome; sick-euthyroid, Non Thyroidal Illness Syndrome, Non-Thyroidal Illness Syndrome, Sick Euthyroid Syndrome, Syndrome, Non-Thyroidal Illness, Syndrome, Sick Euthyroid, Syndromes, Non-Thyroidal Illness
Italian Sindrome tireopatica eutiroidea, Sindrome del malato non-tiroideo, Sick Euthyroid Syndrome, Euthyroid Sick Sindromes
Japanese 甲状腺機能正常症候群, ｺｳｼﾞｮｳｾﾝｷﾉｳｾｲｼﾞｮｳｼｮｳｺｳｸﾞﾝ, 低T3状態, 甲状腺機能正常な病的症候群, 低T3T4症候群, 低T3症候群, トリヨードサイロニン低下状態, 高テトラヨードサイロニン症候群, 高T4症候群, 甲状腺機能正常患者症候群
Swedish Euthyroid-sick syndromes
Czech eutyreoidální 'sick' syndromy, Eutyreoidní sick syndrom
Finnish Korkea T4 -oireyhtymä
Russian VYSOKOGO POKAZATELIA T4 SINDROM, EUTIREOIDNYE SINDROMY, NIZKOGO POKAZATELIA T3 I T4 SINDROM, NIZKOGO POKAZATELIA T3 SINDROM, ВЫСОКОГО ПОКАЗАТЕЛЯ T4 СИНДРОМ, НИЗКОГО ПОКАЗАТЕЛЯ T3 И T4 СИНДРОМ, НИЗКОГО ПОКАЗАТЕЛЯ T3 СИНДРОМ, ЭУТИРЕОИДНЫЕ СИНДРОМЫ
Polish Zespoły z nieprawidłowym poziomem hormonów tarczycy, Nieprawidłowy poziom T3 i T4 w eutyreozie
Hungarian Euthyroid betegség syndroma
Dutch sick-euthyroid; syndroom, syndroom; sick-euthyroid, euthyroid sick syndrome, Syndroom, sick euthyroid
Spanish síndrome del enfermo eutiroideo (trastorno), síndrome del enfermo eutiroideo, Síndrome del enfermo eutiroideo, Sindromes de Eutiroidismo Enfermo, Síndromes del Eutiroideo Enfermo, Síndromes de Eutiroidismo Enfermo, Sindromes del Eutiroideo Enfermo
Portuguese Síndrome de doença eutiróide, Síndromes do Eutireóideo-Doente
French Syndrome des maladies générales chez un euthyroïdien, Syndrome euthyroïdien, Syndrome normothyroïdien
German Euthyroid Sick Syndrom, Euthyroid-Sick-Syndrome
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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