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The Natural History of Subclinical Hyperthyroidism in Graves' Disease: The Rule of Thirds

Lookup NU author(s): Dr Sviatlana Zhyzhneuskaya, Dr Jolanta Weaver, Dr Salman Razvi

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Abstract

Background: There is little information regarding the natural history of subclinical hyperthyroidism (SH) due to Graves' disease (GD).Methods: A prospective analysis was conducted of patients with SH due to GD between 2007 and 2013 with at least 12 months of follow-up. SH was diagnosed if serum thyrotropin (TSH) was below the laboratory reference range (0.4-4.0 mIU/L) and when thyroid hormones were normal. GD was confirmed by either a raised TSH receptor antibody (TRAb) level or uniform uptake on Technetium scan.Results: Forty-four patients (89% female, 16% current smokers, and 5% with active Graves' orbitopathy) were diagnosed with SH due to GD. Over the follow-up period (median 32 months), approximately one third (34%) of the cohort progressed to overt hyperthyroidism, one third (34%) normalized their thyroid function, slightly less than one third (30%) remained in the SH state, while one person became hypothyroid. Multivariate regression analysis showed that older age and positive antithyroid peroxidase (TPO) antibody status had a positive association with risk of progression to overt hyperthyroidism, with hazard ratios of 1.06 ([confidence interval (CI) 1.02-1.10], p < 0.01) per year and 10.15 ([CI 1.83-56.23], p < 0.01), respectively, independent of other risk factors including, smoking, TRAb levels at diagnosis, and sex.Conclusions: A third each of patients with SH due to GD progress, normalize, or remain in the SH state. Older people and those with positive anti-TPO antibodies have a higher risk of progression of the disease. These novel data need to be verified and confirmed in larger cohorts and over longer periods of follow-up.


Publication metadata

Author(s): Zhyzhneuskaya S, Addison C, Tsatlidis V, Weaver JU, Razvi S

Publication type: Article

Publication status: Published

Journal: Thyroid

Year: 2016

Volume: 26

Issue: 6

Pages: 765-769

Print publication date: 13/06/2016

Online publication date: 10/05/2016

Acceptance date: 02/04/2016

ISSN (print): 1050-7256

ISSN (electronic): 1557-9077

Publisher: Mary Ann Liebert, Inc.

URL: http://dx.doi.org/10.1089/thy.2015.0470

DOI: 10.1089/thy.2015.0470


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