Subclinical hyperthyroidism in the course of autonomous nodules — clinical evaluation
Abstract
Introduction: Subclinical hyperthyroidism (SCH), also known as mildly symptomatic hyperthyroidism, has recently been diagnosed more frequently. One of the main endogenous causes of this disorder is autonomously functioning thyroid nodule (AFTN). Despite the fact that it is usually asymptomatic, SCH entails repercussions on the cardiovascular system and bone, and it carries a risk of progression to overt hyperthyroidism with a typical clinical picture. Treatment is still controversial, and its benefits are widely debated in literature.
Material and methods: From 459 patients authors selected a group of 49 patients (10.6% of all subjects with hyperthyroidism), 41 women (83.7%) with AFTN at the stage SCH treated in the Outpatient Endocrinological Clinic and the Department of Endocrinology of the Medical University of Lublin over a three-year period. The method applied in the study was a retrospective analysis of medical records with a particular account of medical history, physical examination, and additional tests obtained during the process of diagnostic and therapeutic procedures.
Results: Forty-one patients (83.7%) suffered from typical symptoms of hyperthyroidism; only eight patients (16.3%) were asymptomatic. The most frequently reported symptoms were tachycardia in women (51.2%) and anxiety in men (50%). The type of thyrostatic drugs and the length of therapy did not affect the outcome of iodine-131 therapy. In the vast majority of the patients (87.8%) radioidodine therapy was effective; 30 patients (61.2%) reached euthyreosis and 13 patients (22.5%) developed hypothyroidism.
Conclusions: Most patients with SCH in the course of AFTN suffered from typical symptoms of overt hyperthyroidism; only every sixth patient was asymptomatic. The volume of autonomous adenomas did not affect the result of 131I therapy; however, the impact of AFTN volume as well as the thyroid volume on RIT efficacy requires futher investigation. In the vast majority of patients 131I therapy was an effective method of treatment, and an earlier therapeutic effect was observed more often in the patients with focal lesions located in the
right lobe.
Keywords: subclinical hyperthyroidismSCHautonomous noduleAFTN131Iradioiodine therapy
References
- Surks MI, Ortiz E, Daniels GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004; 291(2): 228–238.
- Strachan MWJ, Walker BR. Choroby układu wewnątrzwydzielniczego. In: Boon NA, Colledge NR, Walker BR. ed. Choroby wewnętrzne Davidsona. Vol. 2. Elsevier Urban & Partner, Wrocław 2009: 646.
- Biondi B, Bartalena L, Cooper DS, et al. The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism. Eur Thyroid J. 2015; 4(3): 149–163.
- Sowiński J, Lewiński A. Choroby tarczycy. In: Milewicz A. ed. Endokrynologia kliniczna. Vol. II. Polskie Towarzystwo Endokrynologiczne, Wrocław 2012: 266.
- Moreno-Reyes R, Kyrilli A, Lytrivi M, et al. Is there still a role for thyroid scintigraphy in the workup of a thyroid nodule in the era of fine needle aspiration cytology and molecular testing? F1000Res. 2016; 5.
- Collet TH, Gussekloo J, Bauer DC, et al. Thyroid Studies Collaboration. Subclinical hyperthyroidism and the risk of coronary heart disease and mortality. Arch Intern Med. 2012; 172(10): 799–809.
- Biondi B, Cooper DS. The clinical significance of subclinical thyroid dysfunction. Endocr Rev. 2008; 29(1): 76–131.
- Jarząb B, Lewiński A, Płaczkiewicz-Jankowska E. Choroby tarczycy. In: Gajewski P, Szczeklik A. ed. Interna Szczeklika. Medycyna Praktyczna, Kraków 2015: 1275–1277.
- Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012; 379(9821): 1142–1154.
- Jarząb B, Sporny S, Lange D, et al. Diagnostyka i leczenie raka tarczycy — rekomendacje polskie. Endokrynol Pol. 2010; 61(5): 518–568.
- Stott DJ, McLellan AR, Finlayson J, et al. Elderly patients with suppressed serum TSH but normal free thyroid hormone levels usually have mild thyroid overactivity and are at increased risk of developing overt hyperthyroidism. Q J Med. 1991; 78(285): 77–84.
- Biondi B, Palmieri EA, Fazio S, et al. Endogenous subclinical hyperthyroidism affects quality of life and cardiac morphology and function in young and middle-aged patients. J Clin Endocrinol Metab. 2000; 85(12): 4701–4705.
- Tylka J, Piotrowicz R. Kwestionariusz oceny jakości życia SF-36 — wersja polska. Kardiol Pol. 2009; 67: 1166–1169.
- Gulseren S, Gulseren L, Hekimsoy Z, et al. Depression, anxiety, health-related quality of life, and disability in patients with overt and subclinical thyroid dysfunction. Arch Med Res. 2006; 37(1): 133–139.
- Sgarbi JA, Villaça FG, Garbeline B, et al. The effects of early antithyroid therapy for endogenous subclinical hyperthyroidism in clinical and heart abnormalities. J Clin Endocrinol Metab. 2003; 88(4): 1672–1677.
- Grabe HJ, Völzke H, Lüdemann J, et al. Mental and physical complaints in thyroid disorders in the general population. Acta Psychiatr Scand. 2005; 112(4): 286–293.
- Brown RS. Autoimmune thyroid disease: unlocking a complex puzzle. Curr Opin Pediatr. 2009; 21(4): 523–528.
- Bahn Chair RS, Burch HB, Cooper DS, et al. American Thyroid Association, American Association of Clinical Endocrinologists. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011; 21(6): 593–646.
- Goldstein R, Hart IR. Follow-up of solitary autonomous thyroid nodules treated with 131I. N Engl J Med. 1983; 309(24): 1473–1476.
- Mariotti S, Caturegli P, Barbesino G, et al. [Radiometabolic therapy of the autonomous thyroid nodule]. Minerva Endocrinol. 1993; 18(4): 155–163.
- Bolusani H, Okosieme OE, Velagapudi M, et al. Determinants of long-term outcome after radioiodine therapy for solitary autonomous thyroid nodules. Endocr Pract. 2008; 14(5): 543–549.
- Ronga G, Filesi M, D'Apollo R, et al. Autonomous functioning thyroid nodules and 131I in diagnosis and therapy after 50 years of experience: what is still open to debate? Clin Nucl Med. 2013; 38(5): 349–353.
- Massaro F, Vera L, Schiavo M, et al. Ultrasonography thyroid volume estimation in hyperthyroid patients treated with individual radioiodine dose. J Endocrinol Invest. 2007; 30(4): 318–322.
