![]() 1 This committee defined subclinical hypothyroidism as “a serum TSH concentration above the statistically defined upper limit of the reference range when serum free T 4 (FT 4) concentration is within its reference range.” Subclinical hyperthyroidism was defined as “a serum TSH concentration below the statistically defined lower limit of the reference range when serum FT 4 and T 3 concentrations are within their reference ranges.” Based on a series of studies, the panel determined that the reference range for serum TSH is 0.45 to 4.50 μU per mL (0.45 to 4.50 mU per L). In 2002, a scientific review and consensus committee, which included representatives from the American Thyroid Association, the American Association of Clinical Endocrinologists, and the Endocrine Society, convened a panel of experts to define subclinical thyroid disease, review the literature concerning risks and benefits of treatment, and make recommendations about evaluation and population-based screening. Subclinical hyperthyroid and hypothyroid disease are laboratory diagnoses. Sick euthyroid syndrome, nonthyroidal illness syndrome, hypothyroidism, pituitary hormone deficiency, thyroid hormone, thyrotropin releasing hormone, TRH. There is little evidence that early treatment alters the clinical course. Euthyroid sick syndrome (ESS) refers to abnormal thyroid levels resulting from an acute illness in a patient with no preexisting or current dysfunction in the thyroid gland. A serum thyroid-stimulating hormone level of less than 0.1 μU per mL is associated with progression to overt hyperthyroidism, atrial fibrillation, reduced bone mineral density, and cardiac dysfunction. There is insufficient evidence that treatment of subclinical hypothyroidism is beneficial. Any illness can alter thyroid function tests, causing a fairly consistent decrease in total T 4 and T 3 concentrations in proportion to the severity of illness. Patients with a serum thyroid-stimulating hormone level greater than 10 μU per mL have a higher incidence of elevated serum low-density lipoprotein cholesterol concentrations however, evidence is lacking for other associations. Euthyroid sick syndrome ( ESS) is a state of adaptation or dysregulation of thyrotropic feedback control 1 wherein the levels of T3 and/or T4 are abnormal, but the thyroid gland does not appear to be dysfunctional. Illness not involving the thyroid gland can alter thyroid function tests and has been labeled nonthyroidal illness or euthyroid sick syndrome. There is good evidence that subclinical hypothyroidism is associated with progression to overt disease. ![]() Most national organizations recommend against routine screening of asymptomatic patients, but screening is recommended for high-risk populations. ![]() Subclinical hyperthyroidism is found in approximately 2 percent of the population. The prevalence of subclinical hypothyroidism is about 4 to 8.5 percent, and may be as high as 20 percent in women older than 60 years. The management of subclinical thyroid dysfunction is controversial. Subclinical thyroid dysfunction is defined as an abnormal serum thyroid-stimulating hormone level (reference range: 0.45 to 4.50 μU per mL) and free thyroxine and triiodothyronine levels within their reference ranges. ![]()
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