Subclinical Thyroid Disorders
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CME ARTICLE
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ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.
CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. Valid September 1 - November 30, 2005. Estimated time: 1 hour
Educational Objectives
1. To understand the laboratory criteria for the recognition of both subclinical hypothyroidism and subclinical hyperthyroidism
2. To recognize the prevalence of subclinical thyroid disorders in the general population and in older persons
3. To understand the clinical consequences associated with subclinical thyroid disorders
4. To learn the current recommendations for treatment of subclinical thyroid disorders as well as the expected effects of treatment
Population surveys have identified a subset of elderly persons with either high or suppressed levels of thyroid-stimulating hormone (TSH) despite normal levels of circulating thyroxine (T4), free T4, triiodothyronine (T3), and free T3. Such individuals with elevated TSH are considered to have subclinical hypothyroidism, whereas those with suppressed TSH are considered to have subclinical hyperthyroidism. There is significant controversy as to whether these subclinical disorders of the thyroid are a normal variant of the aging process, whether they represent a disease state, and whether they warrant treatment. This review addresses the clinical consequences of subclinical hypothyroidism and subclinical hyperthyroidism, the effect of treatment, and areas of controversy, and will attempt to formulate recommendations for management based on current information.
The identification of relatively large numbers of older persons with subclinical thyroid disorders has come about largely as a consequence of recommendations that screening for thyroid dysfunction should be initiated in the general population as a means of early detection of altered thyroid function.
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