Subclinical Hyperthyroidism

Toft, A. D.

doi:10.1056/nejmcp010145

Cited by 204 publications

(116 citation statements)

References 34 publications

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“…In 1999, Greenspan & Greenspan suggested that exogenous hyperthyroidism seemed to have an adverse effect on bone, which was greater in postmenopausal women (Greenspan & Greenspan 1999). Two years later, Toft reported that the evidence of exogenous subclinical hyperthyroidism as a risk factor for osteoporosis was inconclusive (Toft 2001). Finally, the 2004 Guidelines for diagnosis and management of subclinical thyroid disease (Surks et al 2004) and Murphy & William's review (Murphy & Williams 2004) suggested that suppressive doses of LT4 had little or no effect on the BMD of premenopausal women or men.…”

Section: Discussionmentioning

confidence: 99%

“…The potential changes in BMD in endogenous or induced subclinical hyperthyroidism remains a controversial issue and previous articles have failed to demonstrate uniform results (McDermott et al 1995, Toft 2001, Quan et al 2002, Murphy & Williams 2004. Owing to the observed 80-90% disease-free survival in differentiated thyroid carcinoma patients at 10 years of follow-up (Gullberg et al 1997) and the recommendations for full suppression of TSH to <0.1 mIU/ml (Harris 2002), the potentially deleterious effect of LT4 treatment in BMD is a matter of concern.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, the quality of evidence on the strength of the association between serum TSH and BMD reported in the American Medical Association guidelines for diagnosis and management of subclinical thyroid disease was negative, or only fair in postmenopausal women with a history of overt hyperthyroidism (Surks et al 2004). The heterogeneity of selected patients, different levels of TSH suppression and measurement techniques for BMD determination could explain this disparity in results (McDermott et al 1995, Toft 2001, Murphy & Williams 2004. A study of skeletal integrity in a homogeneous cohort of women under long-term treatment with LT4 for differentiated thyroid carcinoma and sustained TSH suppression is presented.…”

Section: Introductionmentioning

confidence: 99%

“…The relationship between hyperthyroidism and accelerated bone turnover has been well defined since it was first described in 1891 (Von Recklinhausen 1891), and hyperthyroidism appears to affect the predominantly cortical bone in the hip and forearm more than the trabecular bone in the spine (Ross 1994). Nevertheless, the effects of subclinical hyperthyroidism (undetectable TSH levels and total triiodothyronine (TT3) and/or free thyroxine (FT4) in normal range) on bone mineral density (BMD) are less well defined (Toft 2001). Despite publication in the last decade of several studies (Franklyn et al 1992, Kung et al 1993, Giannini et al 1994, Marcocci et al 1994, McDermott et al 1995, Muller et al 1995, Rosen et al 1998) and meta-analyses on this topic (Faber & Galloe 1994, Uzzan et al 1996, evidence that subclinical hyperthyroidism affects skeletal integrity and is therefore a risk factor for osteoporosis, is inconclusive (Greenspan & Greenspan 1999, Toft 2001, Quan et al 2002, Murphy & Williams 2004.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, the effects of subclinical hyperthyroidism (undetectable TSH levels and total triiodothyronine (TT3) and/or free thyroxine (FT4) in normal range) on bone mineral density (BMD) are less well defined (Toft 2001). Despite publication in the last decade of several studies (Franklyn et al 1992, Kung et al 1993, Giannini et al 1994, Marcocci et al 1994, McDermott et al 1995, Muller et al 1995, Rosen et al 1998) and meta-analyses on this topic (Faber & Galloe 1994, Uzzan et al 1996, evidence that subclinical hyperthyroidism affects skeletal integrity and is therefore a risk factor for osteoporosis, is inconclusive (Greenspan & Greenspan 1999, Toft 2001, Quan et al 2002, Murphy & Williams 2004. The meta-analyses and systematic reviews reported either a decrease in bone mineral density during prolonged subclinical hyperthyroidism, mainly in postmenopausal women, or no changes (Faber & Galloe 1994, Uzzan et al 1996, Greenspan & Greenspan 1999, Lau et al 2001, Toft 2001, Quan et al 2002, Murphy & Williams 2004.…”

Section: Introductionmentioning

confidence: 99%

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Lack of deleterious effect on bone mineral density of long-term thyroxine suppressive therapy for differentiated thyroid carcinoma

Reverter

Holgado²,

Alonso³

et al. 2005

Endocr Relat Cancer

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The effect of subclinical hyperthyroidism on bone mineral density is controversial and could be significant in patients with differentiated thyroid carcinoma who receive suppressive doses of levothyroxine (LT4). To ascertain whether prolonged treatment with LT4 to suppress thyrotropin had a deleterious effect on bone mineral density and/or calcium metabolism in patients thyroidectomized for differentiated thyroid cancer we have performed a cross-sectional study in a group of 88 women (meantSD age: 51t12 years) treated with LT4 after near-total thyroidectomy and in a control group of 88 healthy women (51t11 years) matched for body mass index and menopausal status. We determined calcium metabolism parameters, bone turnover marker N-telopeptide and bone mass density by dual-energy X-ray absorptiometry. No differences were found between patients and controls in calcium metabolism parameters or N-telopeptide except for PTH, which was significantly increased in controls. No differences were found between groups in bone mineral density in femoral neck (0.971t0.148 gr/cm 2 vs 0.956t0.130 gr/cm 2 in patients and controls respectively, P = 0.5). In lumbar spine, bone mineral density values were lower in controls than in patients (1.058t0.329 gr/cm 2 vs 1.155t0.224 gr/cm 2 respectively, P<0.05). When premenopausal (n = 44) and postmenopausal (n = 44) patients were compared with their respective controls, bone mineral density was similar both in femoral neck and lumbar spine. The proportion of women with normal bone mass density, osteopenia and osteoporosis in patient and control groups was similar in pre-and postmenopausal women. In conclusion, long-term suppressive LT4 treatment does not appear to affect skeletal integrity in women with differentiated thyroid carcinoma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Lack of deleterious effect on bone mineral density of long-term thyroxine suppressive therapy for differentiated thyroid carcinoma

Reverter

Holgado²,

Alonso³

et al. 2005

Endocr Relat Cancer

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Subclinical Thyroid Dysfunction and Incident Hip Fracture in Older Adults

Lee¹,

Bůžková²,

Fink³

et al. 2010

Arch Intern Med

122

101

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Background Subclinical thyroid dysfunction is common in older adults and affects bone metabolism, but its effects on fracture risk have not been reported. We sought to determine prospectively whether older men and women with subclinical hyperthyroidism or hypothyroidism have an increased risk of hip fracture. Methods Prospective cohort of 3567 US community-dwelling adults, 65 years or older, with biochemically defined subclinical thyroid dysfunction or euthyroidism was enrolled from June 10, 1989, through May 30, 1990, and followed up through 2004. Main outcome measures included incidence and hazard ratios (HRs), with 95% confidence intervals (CIs), of confirmed incident hip fractures for groups with subclinical hypothyroidism, subclinical hyperthyroidism, and euthyroidism as defined at baseline. Results During 39 952 person-years (median follow-up, 13 years), hip fracture incidence (per 1000 men-years) was 13.65 in men with subclinical hyperthyroidism (n = 29) and 10.27 in men with subclinical hypothyroidism (n = 184), both greater than 5.0 in men with euthyroidism (n = 1159). Men with subclinical hypothyroidism had a multivariable-adjusted HR of 2.31 (95% CI, 1.25–4.27); those with subclinical hyperthyroidism, 3.27 (0.99–11.30). After excluding those with baseline use of thyroid-altering medications, men with endogenous subclinical hyperthyroidism had a higher HR of 4.91 (95% CI, 1.13–21.27), as did men with endogenous subclinical hypothyroidism (2.45, 1.27–4.73). Hip fracture incidence (per 1000 women-years) was 8.93 in women with subclinical hypothyroidism (n = 359) and 10.90 in women with subclinical hyperthyroidism (n = 142) compared with 10.18 in women with euthyroidism (n = 1694). No clear association between subclinical dysfunction and fracture was observed in women. Conclusions Older men with subclinical hyperthyroidism or hypothyroidism are at increased risk for hip fracture. Whether treatment of the subclinical syndrome reduces this risk is unknown.

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Subclinical Thyroid Disease

Surks

Ortíz

Daniels

et al. 2004

JAMA

1,557

410

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UBCLINICAL OR "MILD" THYROID disease is a common disorder, particularly in middle-aged and elderly individuals. 1 Greater sensitivity of assays and more frequent assessment of serum thyroidstimulating hormone (TSH) levels have resulted in more patients requiring interpretation of abnormal thyroid function test results. However, controversy surrounds the definition, clinical importance, and necessity for prompt diagnosis and treatment of subclinical thyroid disease. Previous review articles 2-6 and position statements 7,8 differ in their conclusions and recommendations, often a consequence of difficulties in interpreting inadequate and conflicting data. In the midst of this uncertainty, clinicians still desire expert guidance for the diagnosis and management of subclinical thyroid disease.

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Subclinical Hyperthyroidism

Cited by 204 publications

References 34 publications

Lack of deleterious effect on bone mineral density of long-term thyroxine suppressive therapy for differentiated thyroid carcinoma

Lack of deleterious effect on bone mineral density of long-term thyroxine suppressive therapy for differentiated thyroid carcinoma

Subclinical Thyroid Dysfunction and Incident Hip Fracture in Older Adults

Subclinical Thyroid Disease

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