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Fortnightly review: Controversial aspects of thyroid disease

1999; BMJ; Volume: 319; Issue: 7214 Linguagem: Inglês

10.1136/bmj.319.7214.894

0959-8138

Fahmy Hanna, John H. Lazarus, M. F. Scanlon,

Ophthalmology and Eye Disorders

The thyroid gland controls the metabolic rate of many organs and tissues Underactivity and overactivity of thyroid function represent the commonest endocrine problems, have widespread manifestations, and often require long term treatment. Therefore, all practising clinicians have to be aware of thyroid physiology and the consequences of dysthyroidism. #### Summary points Simplifying the treatment regimen for thyroid disease is the most important way of improving patient compliance All solitary thyroid nodules should be examined by fine needle aspiration; the technique may also be helpful in multinodular goitres if carcinoma is suspected Subclinical hyperthyroidism is defined as suppressed concentrations of thyroid stimulating hormone with normal serum thyroxine and triiodothyronine concentrations In subclinical hyperthyroidism the incidence of atrial fibrillation increases as thyroid stimulating hormone concentrations decrease, and in postmenopausal women bone mineral density may also be slightly reduced Smoking increases the risk of both Graves' disease and Graves' ophthalmopathy We have chosen topics in thyroid disease of interest to clinicians in both primary and secondary care: compliance, because it remains a challenge to all clinicians; and subclinical thyroid disease and the effect of amiodarone on thyroid function because they are interesting and evolving topics. We have also addressed some aspects of Graves' disease that have recently generated interest. Our sources included papers from Medline as well as discussions from recent national and international endocrinology meetings. ### Box 1 —Causes of increased thyroid stimulating hormone concentrations with adequate thyroxine replacement dose #### Reduced absorption Sucralfate Cholestyramine Ferrous sulphate Aluminium hydroxide #### Reduced conversion of thyroxine to triiodothyronine Amiodarone Management of thyroid disorders usually requires prolonged, and often lifelong, courses of treatment. Hence adequate compliance is needed to achieve and maintain euthyroidism. The sensitive assay for thyroid stimulating hormone has advantages over assays for thyroxine, triiodothyronine, and free thyroxine, and both the free thyroxine index and older versions of the thyroid stimulating hormone radioimmunoassay. The sensitive assay helps to differentiate normal concentrations of thyroid stimulating …