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Subklinisk hypertyreos

Senast reviderad:
Sakkunnig:
Definition:
Subklinisk hypertyreos definieras som lågt eller inte mätbart TSH med samtidiga normala värden på FT4 och FT3.
Förekomst:
Prevalensen verkar vara <1 %.
Symtom:
Även om tillståndet per definition är utan symtom kan ospecifika symtom och tecken på tyreotoxikos förekomma.
Kliniska fynd:
Som regel normala fynd, bedöm eventuell struma och förmaksflimmer.
Diagnostik:
TSH, FT4, FT3 och autoantikroppar för tyreoidea.
Behandling:
Eventuellt behandling beroende på TSH-värde, ålder och riskfaktorer.
  1. Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012 Mar 24;379(9821):1142-54. doi: 10.1016/S0140-6736(11)60276-6. Epub 2012 Jan 23. PMID: 22273398 PubMed  
  2. Franklyn JA. The thyroid--too much and too little across the ages. The consequences of subclinical thyroid dysfunction. Clin Endocrinol (Oxf). 2013 Jan;78(1):1-8. doi: 10.1111/cen.12011. PMID: 22891671 PubMed  
  3. U.S. Preventive Services Task Force. Screening for thyroid disease: recommendation statement. Ann Intern Med. 2004 Jan 20;140(2):125-7. doi: 10.7326/0003-4819-140-2-200401200-00014. PMID: 14734336 PubMed  
  4. Surks MI, Ortiz E, Daniels GH, et al. Subclinical Thyroid Disease. Scientific Review and Guidelines for Diagnosis and Management. JAMA 2004; 291: 228-38. PMID: 14722150 PubMed  
  5. Bjøro T, Holmen J, Krüger Ø, et al. Prevalence of thyroid disease, thyroid dysfunction and thyroid peroxidase antibodies in a large, unselected population. The Health Study of Nord-Trùndelag (HUNT). Eur J Endocrinol 2000; 143: 639-47. PMID: 11078988 PubMed  
  6. Helfand M. Screening for subclinical thyroid dysfunction in nonpregnant adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2004; 140: 128-41. PMID: 14734337 PubMed  
  7. Donangelo I, Braunstein GD. Update on subclinical hyperthyroidism. Am Fam Physician. 2011 Apr 15;83(8):933-8. PMID: 21524033 PubMed  
  8. Nationellt kliniskt kunskapsstöd, NKK. Nationellt vårdprogram för hypertyreos. Hämtad 2023-05-30 www.nationelltklinisktkunskapsstod.se  
  9. Faber J, Galloe AM. Changes in bone mass during prolonged subclinical hyperthyroidism due to L-thyroxine treatment: a meta-analysis. Eur J Endocrinol 1994; 130: 350-6.
  10. 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 Sep;4(3):149-63. PMID: 26558232 PubMed  
  11. Donangelo I, Suh SY. Subclinical Hyperthyroidism: When to Consider Treatment. Am Fam Physician. 2017 Jun 1;95(11):710-716. PMID: 28671443 PubMed  
  12. Wiersinga WM. Subclinical hypothyroidism and hyperthyroidism. I. Prevalence and clinical relevance. Neth J Med 1995; 46: 197-204.
  13. Cappola AR, Fried LP, Arnold AM, et al. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA 2006; 295: 1033-41. PMID: 16507804 PubMed  
  14. Baumgartner C, da Costa BR, Collet TH, et al. Thyroid Function Within the Normal Range, Subclinical Hypothyroidism, and the Risk of Atrial Fibrillation. Circulation 2017; 136: 2100. pmid:29061566 PubMed  
  15. Parle JV, Maisonneuve P, Sheppard MC, Boyle P, Franklyn JA. Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study . Lancet 2001; 358: 861-5.
  16. Blum MR, Bauer DC, Collet T-H, et al. Subclinical thyroid dysfunction and fracture risk. A meta-analysis. JAMA 2015; 313: 2055-65. doi:10.1001/jama.2015.5161. PMID: 26010634 PubMed  
  17. van Vliet NA, Van Heemst D, Almeida Op, Åsvold BO, et al. Association of thyroid dysfunction with cognitive function: An individual participant data analysis. JAMA Intern Med 2021. PMID: 34491268 PubMed  
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet