Management of subclinical hyperthyroidism presented by several cases

Abstract

Subclinical hyperthyroidism (ScHyper) is a condition with suppressed TSH, and normal free T3 and free T4 hormones, affecting 10% of the population. There are two subgroups of patients, the first group with TSH lower than 0.1 U/l, and the second group with mildly suppressed TSH between 0.1 and the lower assay reference limit. The patients from the first group should be treated, but there is no evidence for therapy for the second group of patients.

We present a three cases from the second group of patients with ScHyper and their different management of the disease. The pregnant women in the first trimester of pregnancy wasn’t treated, just observed. The TSH spontaneously normalized in the second trimester of pregnancy. Patient with ScHyper caused by Graves’ disease was treated only with beta blocker because of tachycardia. And, older women with multinodular goiter, who refused iodine 131 therapy, was treated with low doses of antithyroid drug and beta blocker. All three were without any complications from the disease. Treatment options of ScHyper are: antithyroid drugs, iodine 131 therapy, and surgery. Which of these will be chosen, or patient will be observed without therapy, depends to the specific causes.