FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 345:260-265 July 26, 2001 Number 4 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

	Full Text PDF Purchase this article Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.

A 59-year-old woman is found to have a serum thyrotropin level of 7 mU per liter on routine screening. Her only symptoms are mild fatigue, which has been present for more than 10 years, and difficulty losing weight. The results of the physical examination are normal, except for the finding of a small, firm thyroid with a slightly irregular surface. The serum . . . [Full Text of this Article]

The Clinical Problem

Strategies and Evidence

Screening

Effects of Therapy

            Prevention of Progression to Overt Hypothyroidism

            Effects on Serum Lipid Levels

            Effects on Symptoms, Mood, and Cognition

            Arguments against Treatment

Areas of Uncertainty

Guidelines

Conclusions and Recommendations

Screening

Thyroxine Therapy

Source Information

From the Division of Endocrinology, Sinai Hospital of Baltimore and Johns Hopkins University School of Medicine, Baltimore.

Address reprint requests to Dr. Cooper at the Division of Endocrinology, Sinai Hospital of Baltimore, Baltimore, MD 21215, or at dcooper@lifebridgehealth.org.

References

This article has been cited by other articles:

• Stylianou, I. M., Langley, S. R., Walsh, K., Chen, Y., Revenu, C., Paigen, B. (2008). Differences in DBA/1J and DBA/2J reveal lipid QTL genes. J. Lipid Res. 49: 2402-2413 [Abstract] [Full Text]  
• Ochs, N., Auer, R., Bauer, D. C., Nanchen, D., Gussekloo, J., Cornuz, J., Rodondi, N. (2008). Meta-analysis: Subclinical Thyroid Dysfunction and the Risk for Coronary Heart Disease and Mortality. ANN INTERN MED 148: 832-845 [Abstract] [Full Text]  
• Karmisholt, J., Andersen, S., Laurberg, P. (2008). Interval between Tests and Thyroxine Estimation Method Influence Outcome of Monitoring of Subclinical Hypothyroidism. J. Clin. Endocrinol. Metab. 93: 1634-1640 [Abstract] [Full Text]  
• Hamilton, T. E., Davis, S., Onstad, L., Kopecky, K. J. (2008). Thyrotropin Levels in a Population with No Clinical, Autoantibody, or Ultrasonographic Evidence of Thyroid Disease: Implications for the Diagnosis of Subclinical Hypothyroidism. J. Clin. Endocrinol. Metab. 93: 1224-1230 [Abstract] [Full Text]  
• Biondi, B., Cooper, D. S. (2008). The Clinical Significance of Subclinical Thyroid Dysfunction. Endocr. Rev. 29: 76-131 [Abstract] [Full Text]  
• Fatourechi, V. (2007). Upper Limit of Normal Serum Thyroid-Stimulating Hormone: A Moving and Now an Aging Target?. J. Clin. Endocrinol. Metab. 92: 4560-4562 [Full Text]  
• Li, J. H., Safford, R. E., Aduen, J. F., Heckman, M. G., Crook, J. E., Burger, C. D. (2007). Pulmonary Hypertension and Thyroid Disease. Chest 132: 793-797 [Abstract] [Full Text]  
• Razvi, S., Ingoe, L., Keeka, G., Oates, C., McMillan, C., Weaver, J. U. (2007). The Beneficial Effect of L-Thyroxine on Cardiovascular Risk Factors, Endothelial Function, and Quality of Life in Subclinical Hypothyroidism: Randomized, Crossover Trial. J. Clin. Endocrinol. Metab. 92: 1715-1723 [Abstract] [Full Text]  
• Peeters, R. P, van der Deure, W. M, Visser, T. J (2006). Genetic variation in thyroid hormone pathway genes; polymorphisms in the TSH receptor and the iodothyronine deiodinases.. Eur J Endocrinol 155: 655-662 [Abstract] [Full Text]  
• Zhu, D.-F., Wang, Z.-X., Zhang, D.-R., Pan, Z.-L., He, S., Hu, X.-P., Chen, X.-C., Zhou, J.-N. (2006). fMRI revealed neural substrate for reversible working memory dysfunction in subclinical hypothyroidism. Brain 129: 2923-2930 [Abstract] [Full Text]  
• Krishnan, S G S, Pathalapati, R, Kaplan, L, Cobbs, R K (2006). Falsely raised TSH levels due to human anti-mouse antibody interfering with thyrotropin assay. Postgrad. Med. J. 82: e27-e27 [Abstract] [Full Text]  
• Johnson, J. L. (2006). Diabetes Control in Thyroid Disease. Diabetes Spectr. 19: 148-153 [Abstract] [Full Text]  
• Jorde, R., Waterloo, K., Storhaug, H., Nyrnes, A., Sundsfjord, J., Jenssen, T. G. (2006). Neuropsychological Function and Symptoms in Subjects with Subclinical Hypothyroidism and the Effect of Thyroxine Treatment. J. Clin. Endocrinol. Metab. 91: 145-153 [Abstract] [Full Text]  
• Rodondi, N., Newman, A. B., Vittinghoff, E., de Rekeneire, N., Satterfield, S., Harris, T. B., Bauer, D. C. (2005). Subclinical Hypothyroidism and the Risk of Heart Failure, Other Cardiovascular Events, and Death. Arch Intern Med 165: 2460-2466 [Abstract] [Full Text]  
• Appelhof, B. C., Peeters, R. P., Wiersinga, W. M., Visser, T. J., Wekking, E. M., Huyser, J., Schene, A. H., Tijssen, J. G. P., Hoogendijk, W. J. G., Fliers, E. (2005). Polymorphisms in Type 2 Deiodinase Are Not Associated with Well-Being, Neurocognitive Functioning, and Preference for Combined Thyroxine/3,5,3'-Triiodothyronine Therapy. J. Clin. Endocrinol. Metab. 90: 6296-6299 [Abstract] [Full Text]  
• Wartofsky, L., Dickey, R. A (2005). The Evidence for a Narrower Thyrotropin Reference Range Is Compelling. J. Clin. Endocrinol. Metab. 90: 5483-5488 [Abstract] [Full Text]  
• Kahaly, G. J., Dillmann, W. H. (2005). Thyroid Hormone Action in the Heart. Endocr. Rev. 26: 704-728 [Abstract] [Full Text]  
• Zoncu, S., Pigliaru, F., Putzu, C., Pisano, L., Vargiu, S., Deidda, M., Mariotti, S., Mercuro, G. (2005). Cardiac function in borderline hypothyroidism: a study by pulsed wave tissue Doppler imaging. Eur J Endocrinol 152: 527-533 [Abstract] [Full Text]  
• Casey, B. M., Dashe, J. S., Wells, C. E., McIntire, D. D., Byrd, W., Leveno, K. J., Cunningham, F. G. (2005). Subclinical Hypothyroidism and Pregnancy Outcomes. Obstet Gynecol 105: 239-245 [Abstract] [Full Text]  
• Gharib, H., Tuttle, R. M., Baskin, H. J., Fish, L. H., Singer, P. A., McDermott, M. T. (2005). 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. 90: 581-585 [Full Text]  
• Gussekloo, J., van Exel, E., de Craen, A. J. M., Meinders, A. E., Frolich, M., Westendorp, R. G. J. (2004). Thyroid Status, Disability and Cognitive Function, and Survival in Old Age. JAMA 292: 2591-2599 [Abstract] [Full Text]  
• Cooper, D. S. (2004). Thyroid Disease in the Oldest Old: The Exception to the Rule. JAMA 292: 2651-2654 [Full Text]  
• Tonacchera, M., Perri, A., De Marco, G., Agretti, P., Banco, M. E., Di Cosmo, C., Grasso, L., Vitti, P., Chiovato, L., Pinchera, A. (2004). Low Prevalence of Thyrotropin Receptor Mutations in a Large Series of Subjects with Sporadic and Familial Nonautoimmune Subclinical Hypothyroidism. J. Clin. Endocrinol. Metab. 89: 5787-5793 [Abstract] [Full Text]  
• Diez, J. J., Iglesias, P. (2004). Spontaneous Subclinical Hypothyroidism in Patients Older than 55 Years: An Analysis of Natural Course and Risk Factors for the Development of Overt Thyroid Failure. J. Clin. Endocrinol. Metab. 89: 4890-4897 [Abstract] [Full Text]  
• Helfand, M. (2004). Screening for Subclinical Thyroid Dysfunction in Nonpregnant Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force. ANN INTERN MED 140: 128-141 [Abstract] [Full Text]  
• Surks, M. I., Ortiz, E., Daniels, G. H., Sawin, C. T., Col, N. F., Cobin, R. H., Franklyn, J. A., Hershman, J. M., Burman, K. D., Denke, M. A., Gorman, C., Cooper, R. S., Weissman, N. J. (2004). Subclinical Thyroid Disease: Scientific Review and Guidelines for Diagnosis and Management. JAMA 291: 228-238 [Abstract] [Full Text]  
• Toscano, E, Pacileo, G, Limongelli, G, Verrengia, M, Di Mita, O, Di Maio, S, Salerno, M, Del Giudice, E, Caniello, B, Calabro, R, Andria, G (2003). Subclinical hypothyroidism and Down's syndrome; studies on myocardial structure and function. Arch. Dis. Child. 88: 1005-1008 [Abstract] [Full Text]  
• Pearce, E. N., Farwell, A. P., Braverman, L. E. (2003). Thyroiditis. NEJM 348: 2646-2655 [Full Text]  
• Peeters, R. P., van Toor, H., Klootwijk, W., de Rijke, Y. B., Kuiper, G. G. J. M., Uitterlinden, A. G., Visser, T. J. (2003). Polymorphisms in Thyroid Hormone Pathway Genes Are Associated with Plasma TSH and Iodothyronine Levels in Healthy Subjects. J. Clin. Endocrinol. Metab. 88: 2880-2888 [Abstract] [Full Text]  
• Toft, A. D, Beckett, G. J (2003). Thyroid function tests and hypothyroidism. BMJ 326: 295-296 [Full Text]  
• Biondi, B., Palmieri, E. A., Lombardi, G., Fazio, S. (2002). Effects of Subclinical Thyroid Dysfunction on the Heart. ANN INTERN MED 137: 904-914 [Abstract] [Full Text]  
• Stagnaro-Green, A. (2002). Postpartum Thyroiditis. J. Clin. Endocrinol. Metab. 87: 4042-4047 [Full Text]  
• Kordonouri, O., Klinghammer, A., Lang, E. B., Gruters-Kieslich, A., Grabert, M., Holl, R. W. (2002). Thyroid Autoimmunity in Children and Adolescents With Type 1 Diabetes: A multicenter survey. Diabetes Care 25: 1346-1350 [Abstract] [Full Text]  
• Huber, G., Staub, J.-J., Meier, C., Mitrache, C., Guglielmetti, M., Huber, P., Braverman, L. E. (2002). Prospective Study of the Spontaneous Course of Subclinical Hypothyroidism: Prognostic Value of Thyrotropin, Thyroid Reserve, and Thyroid Antibodies. J. Clin. Endocrinol. Metab. 87: 3221-3226 [Abstract] [Full Text]  
• Johnson, J. L., Duick, D. S. (2002). Diabetes and Thyroid Disease: A Likely Combination. Diabetes Spectr. 15: 140-142 [Full Text]  
• Dashe, J. S., Cunningham, F. G., Mazziotti, A., Press, M., Cooper, D. S. (2001). Subclinical Hypothyroidism. NEJM 345: 1855-1856 [Full Text]  
• Toft, A. D. (2001). Subclinical Hyperthyroidism. NEJM 345: 512-516 [Full Text]