the main therapeutic option is observation - TSH levels must be confirmed as persistently low before action is taken - treatment may be indicated if subclinical hyperthyroidism develops into frank thyrotoxicosis
treatment should be considered in elderly patients with atrial fibrillation if there was a large goitre or there were risk factors for cardiovascular or musculoskeletal disease
some guidance suggests "..treatment of subclinical hyperthyroidism is recommended in elderly patients with undetectable serum TSH for the increased risk of atrial fibrillation, osteoporosis and bone fractures and for the higher risk of progression to overt disease.." (2)
clinicians usually distinguish mild subclinical hyperthyroidism when the serum TSH level is low, but still detectable (0.1-0.4 mU/L), from a more severe condition in which TSH is undetectable and fully suppressed
also treatment should also be considered in symptomatic young patients with persistent undetectable serum TSH (<0.1 mU/L), especially in presence of underlying heart disease
both anti-thyroid drugs and radioiodine treatment are options in the treatment of subclinical hyperthyroidism with undetectable TSH
surgery should be considered in all patients with evidence of airway compression
NICE have issued guidance on subclinical hypothyroidism management (3):
treating subclinical hyperthyroidism
consider seeking specialist advice on managing subclinical hyperthyroidism in adults if they have:
2 TSH readings lower than 0.1mIU/litre at least 3months apart and evidence of thyroid disease (for example, a goitre or positive thyroid antibodies)
or symptoms of thyrotoxicosis
consider seeking specialist advice on managing subclinical hyperthyroidism in all children and young people
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