From the Research
Patients with subclinical hyperthyroidism should have their TSH levels retested every 3-6 months initially, with follow-up intervals potentially extending to 6-12 months if levels remain stable. This recommendation is based on the most recent and highest quality study available, which suggests that the majority of patients with subclinical hyperthyroidism remain stable or revert to normal thyroid function over time 1. For patients with mildly suppressed TSH (0.1-0.4 mIU/L), retesting should occur at 3-6 month intervals to monitor for progression or resolution. Those with more severely suppressed TSH (<0.1 mIU/L) may need more frequent monitoring, typically every 3 months, as they have a higher risk of progression to overt hyperthyroidism. Some key points to consider when managing subclinical hyperthyroidism include:
- The risk of progression to overt hyperthyroidism is relatively low, with only 0.5-0.7% of patients developing hyperthyroidism at 2,5, and 7 years after diagnosis 1
- A larger proportion of patients with subclinical hyperthyroidism revert to normal thyroid function over time, with 17.2% reverting to normal at 2 years, 31.5% at 5 years, and 35.6% at 7 years 1
- Regular TSH monitoring is important to determine the appropriate management strategy, whether it's continued observation or initiation of treatment, especially in high-risk patients such as the elderly or those with cardiovascular disease or osteoporosis
- Treatment options for subclinical hyperthyroidism may include antithyroid drugs, radioactive iodine ablation, and surgery, although treatment is typically only recommended for patients at highest risk of osteoporosis and cardiovascular disease, such as those older than 65 years or with persistent serum thyrotropin level less than 0.1 mIU/L 2.