Subclinical thyreopathies

Authors: K. Drbalová;  K. Herdová;  P. Pačesová;  M. Šimon
Authors‘ workplace: Endokrinologický ústav, Praha, ředitel doc. MUDr. Vojtěch Hainer, CSc.
Published in: Vnitř Lék 2006; 52(10): 963-968
Category: Review


Subclinical thyreopathies are pathological states of the thyroid gland that show no corresponding clinical symptoms, yet may be detected sporadically by laboratory examination or screening methods. They represent a novel diagnostic entity (analogous to glucose tolerance impairment – IGT or impaired fasting glycemia – IFG), which appeared due to innovations in laboratory diagnostics (sensitive TSH detection methods) and recent focus on pre-clinical stages of manifestative diseases. From a wider point of view, subclinical thyreopathies include subclinical hypothyreosis, subclinical hyperthyreosis, thyroid volume or structure changes found accidentally by sonography, initial stages of malignancy – accidental detection of a micro-carcinoma and subclinical forms of thyroiditis. Controversy remains concerning exact definition, epidemiological issues, therapeutic intervention, evaluation of risk and gain implied in treatment of these borderline clinical stages and, last but not least, early screening of risk groups if necessary.

Key words:
not included


1. Bauer DC, Ettinger B, Nevitt M et al. For the Study of Osteoporotic Fracture Research Group. Risk for fracture in women with low serum levels of thyroid stimulating hormone. Ann Inter Med 2001; 134: 561-568.

2. Biondi B, Palmieri EA, Lombardi G et al. Effects of subclinical thyroid dysfunction on the heart. Ann Intern Med 2002; 137: 904-914.

3. Biondi B, Palmieri EA, Klain M et al. Subclinical hyperthyroidism: Clinical features and treatement options. Eurropean Journal of Endocronologists 2005; 152: 1-9.

4. Canaris GJ, Manowitz NR, Mayor G et al. The Colorado thyroid disease prevalence study. Arch Intern Med 2000; 160: 526-534.

5. Casey BM, Dashe JS, Wells CE et al. Subclinical hypotyroidism and Pregnancy Outcomes. The American College of Obstetricians and Gynecologists 2005; 2: 239-245.

6. Col NF, Surks MI, Daniels GH. Subclinical Thyroid Disease. JAMA 2004; 291: 239-243.

7. Danese MD, Ladenson PW, Meinert CL et al. Effect of tyroxine therapy on serum lipoproteins in patients with mild thyroid failure: a quantitative rewiew of literature. J Clin Endocrinol Metab 2000; 85: 2993-3001.

8. Duntas LH. Subclinical thyroid disorders: The menace of Trojan horse. J Clin Invest 2003; 36: 472-480.

9. Duntas LH. Thyroid Disease and Lipids. Thyroid 2002; 4: 287-293.

10. Faber J, Jensen IW, Petersen L et al. Normalization of serum thyreotropin by means of radioiodine treatment in subclinical hyperthyroidism: effect on bone loss in postmenopauzal women. Clin Endocrinol (Oxf) 1998; 48: 285-290.

11. Fukata S, Kuma K, Sugawara M. Relationship between cigarettte smoking and hypothyroidism in patiens with Hashimotoś thyroiditis. J Endocrinol Investic 1996; 19: 607-612.

12. Gharib H, Tuttle RM, Baskin HJ et al. Consensus Statement: Subclinical Thyroid Dysfunctiuon:A Joint Statement on Management from the American Association of Clinical Endocrinologist, the American Thyroid Association, and The Endocrine Society. J Clin Endocr Metab 2005; 90: 581-585.

13. Haddow JE, Palomaki GE, Allan WC et al. Materna Thyroid deficiency during pregnancy and subsequent neuropsychological development of the child. N Engl J Med 1999; 341: 549-555.

14. Hollowell J, Staehling NW, Flanders WD et al. Serum TSH, T4, and thyroid antibodies in the United States population (1988 to1994): National Health and Nutrition Examination Survey (NHANESIII). J Clin Endocrinol Metab 2002; 87: 489-499.

15. Chadarevian R, Bruckert E, Leenhardt L et al. Components of the fibrinolytic system are differently altered in moderate and severe hypotyroidism. Clin Endocrinol Metab 2001; 86: 732-737.

16. Kalmijn S, Mehta KM, Pols HAP et al. Subclinical hypertyroidism and the risk of dementi. The Rotterdam study. Clin Endocrinol (Oxf) 2000; 53: 733-737.

17. Ladenson PW. Tyrotoxicosis and the heart: old and something new. J Clin Endocrin Metab 1993; 77: 332-333.

18. Lekakis J, Papamichael C, Alevizaki M et al. Flow-mediated, endothelium-dependent vasodilatation is impaird in subjekt with hypothyroidism, borderline hypothyroidism, and high-normal serum thyrotropin (TSH) values. Thyroid 1997; 7: 411-414.

19. Mayer O jr. Je subklinická hypotyreóza rizikovým faktorem kardiovaskulárních chorob? Cor Vasa 2004; 46: 123-127.

20. Meier C, Strub JJ, Roth CB et al. TSH-controlled L-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypoyroidism: a double blind, placebo controlled trial (Basel Thyroid Study). J Clin Endocrinol Metab 2001; 86: 4860-4866.

21. Parle JV, Maisonneuve P, Sheppard MC. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet 2001; 358: 861-865.

22. Parle JV, Franklyn JA, Gross KW et al. Prevalence and folow-up of abnormal thyrotropin (TSH) concentrations in the elderly in the United Kingdom. Clin Endocrinol (Oxf) 1991; 34: 77-83.

23. Pinchera A. Subclinical Thyroid Disease: To Treat Not To Treat? Thyroid 2005; 1: 1-2.

24. Sawin CT, Geller A, Wolf PA et al. Low serum thyrotropin contrencation as a risk factor for atrial fibrilation in older person. N Engl J Med 1994; 331: 1249-1252.

25. Surks MI, Oritz E, Daniels GH at al. Subclinical Thyroid Disease. JAMA 2004; 291: 228-238.

26. Surks MI. Commentary: Subclinical Thyroid Dysfunctiuon: A Joint Statement on Management from the American Association of Clinical Endocrinologist, the American Thyroid Association, and The Endocrine Society. J Clin Endocr Metab 2005; 90: 586-587.

27. Tauchmanova L, Nizzo V, Fonderico F et al. Reduced bone mass detected by bone quantitative ultrasonometry and DEXA in pre- and postmenopausal women with endogenous subclinical hyperthyroidism. Maturitas 2004; 3: 299-306.

28. Vanderpump MP, Tunbridge WM, French JM et al. The development of ischemic heart disease in relation to autoimunite thyroid disease in a 20-year follow-up study of an English community. Thyroid 1996; 6: 155-160.

29. Zamrazil V. Subklinické tyreopatie. Interní medicína pro praxi 2004; 6: 295-299.

Diabetology Endocrinology Internal medicine
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account