Michael T. McDermott, MD
McDermott M.; Hyperthyroidism. Ann Intern Med. 2012;157:ITC1-1. doi: 10.7326/0003-4819-157-1-201207030-01001
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Published: Ann Intern Med. 2012;157(1):ITC1-1.
Hyperthyroidism is a clinical state characterized by excessive serum concentrations of thyroxine (T4), triiodothyronine (T3), or both with suppression of serum thyroid-stimulating hormone (TSH) levels. Some observers prefer the term thyrotoxicosis for this condition and restrict the term hyperthyroidism to the types of thyrotoxicosis that are caused when the thyroid gland synthesizes and secretes too much thyroid hormone. To avoid confusion, however, we will consider hyperthyroidism and thyrotoxicosis to be the same and will use only the term hyperthyroidism.
Hyperthyroidism is considered to be "overt" when a low serum TSH level is associated with elevated serum levels of free or total T4 and/or free or total T3. Hyperthyroidism is considered to be "subclinical" when a low serum TSH level is associated with serum T4 and T3 levels that are within the population reference range. Therefore, the terms overt and subclinical are defined biochemically without reference to clinical features. Although symptoms and signs are usually prominent in overt hyperthyroidism, they may or may not be present in subclinical hyperthyroidism. The prevalence of hyperthyroidism in the United States is estimated to be about 0.4%–1.2%, with approximately 40% of cases being overt and 60% being subclinical (1–3).
July 8, 2012
Table 1 Frequencies of Symptoms and Signs
Table 1 was referenced as from a paper published in 1946... I suspect with our current laboratory testing methods that patients are seen earlier in the disease course. I'm skeptical that the frequencies of symptoms and signs fits current clinical experience. Are there not more recent data?
Mark Antony LaPorta MD FACP
Private Practice and Locum Tenens
August 31, 2013
Endocrinology by the Numbers
As a well-educated and diligent general internist, it is my observation that endocrinologists --"thyroidologists" in particular -- would have us become accountants. This article reinforces that observation. I am dedicated to the concept that my patient is more than numbers, even number representing state and molecules, and I encourage my academic (have you looked up the etymology and definition of that word lately?) colleagues to bear that in mind when treating the body in the seat. To wit: I remain thoroughly unconvinced about "subclinical hypothyroidism" and I maintain that thyrotoxicosis is a clinical and physiological state, not entirely congruent with your numerical measurements. While we're at it, remember the carpenter's dictum: "measure twice, cut once."
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Endocrine and Metabolism, Thyroid Disorders.
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