Dr. Sheldon Rubenfeld Board Certified in Internal Medicine and in Endocrinology, Diabetes, and Metabolism

Subclinical Hyperthyroidism

Treatment of Patients with Subclinical Hyperthyroidism

The treatment of patients with subclinical hyperthyroidism is controversial. While most patients with subclinical hyperthyroidism do not progress to overt hyperthyroidism, some patients are at greater risk of complications than other patients are. Therefore, the treatment of patients with subclinical hyperthyroidism must be individualized. For example, physicians may be more likely to treat older women with osteoporosis and heart disease than younger, otherwise healthy women. In fact, one study suggested that subclinically hyperthyroid patients over sixty years of age have an increased mortality rate during the ten years following the initial finding of a low TSH level. The primary cause of the increased number of deaths was heart disease.   

Nonetheless, there is no evidence yet that treatment of patients with subclinical hyperthyroidism prevents the increased mortality.

Once the decision to treat is made, subclinically hyperthyroid patients are generally treated in the same ways as overtly hyperthyroid patients. Subclinically hyperthyroid patients with Graves’ disease, however, are more likely to be treated with antithyroid drugs than with either radioactive iodine or surgery. There are two reasons for this prudent approach. First, many patients with subclinical hyperthyroidism have small goiters, making remission more likely. Second, physicians are reluctant to destroy a thyroid gland that may be causing no symptoms when other treatments are available.