An update on subclinical hypothyroidism and subclinical hyperthyroidism

Mitra M. Fatourechi, Vahab Fatourechi

Research output: Contribution to journalReview articlepeer-review

2 Scopus citations


Subclinical thyroid dysfunction is characterized by normal levels of peripheral thyroid hormone, paired with a TSH level that is either lower than (subclinical hyperthyroidism) or higher than (subclinical hypothyroidism) the normal laboratory reference range. Slight shifts in peripheral hormone levels result in significant serum TSH changes. The exact upper limit of normal TSH and the management of subclinical hypothyroidism are still controversial. For those with TSH between high upper limit of normal and 10 mIU/L, the authors suggest selective use of thyroxine therapy. The authors agree with the general consensus in favor of therapy for those with serum TSH levels above 10 mIU/L. This recommendation is compatible with guidelines of American Thyroid Association and American Association of Clinical Endocrinologists. For subclinical hyperthyroidism persistent serum TSH <0.1 mIU/L should be treated particularly if the etiology is nodular toxic goiter. For serum TSH between 0.1 mIU/L and lower limit of normal, serum TSH co-morbidities such as cardiac risk factors and osteoporosis may favor therapy.

Original languageEnglish (US)
Pages (from-to)137-151
Number of pages15
JournalExpert Review of Endocrinology and Metabolism
Issue number2
StatePublished - Mar 2014


  • Antithyroid antibodies
  • Autoimmune thyroid disease
  • Cardiac risk factors
  • Hyperthyroidism
  • Hypothyroidism
  • Screening with TSH
  • Subclinical hyperthyroidism
  • Subclinical hypothyroidism
  • Suppressed TSH
  • Thyroxine therapy

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


Dive into the research topics of 'An update on subclinical hypothyroidism and subclinical hyperthyroidism'. Together they form a unique fingerprint.

Cite this