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Prognostic value of subclinical hyperthyroidism in an internal medicine ward

2013; Elsevier BV; Volume: 24; Linguagem: Inglês

10.1016/j.ejim.2013.08.256

1879-0828

M. Fernanda R. P. Proença, Rosa Cardiga, Inês Araújo, F. Marques, Silvia Jesús, D. Cardoso, Sofia Serra, Cândida Fonseca, Ana Lúcia Leitão, Fátima Ceia,

Thyroid Cancer Diagnosis and Treatment

Introduction: Subclinical hyperthyroidism is a relatively common condition, especially in the elderly, and is associated with major cardiovascular risk factors. There are no clear recommendations for its management. Objectives: To determine how doctors in an internal medicine ward manage subclinical hyperthyroidism, its consequences and short and long-term prognosis. Methods: Prospective study of patients (pts) consecutively admitted over one year. We compared clinical characteristics, in-hospital and long-term mortality (322 ± 227 days) of pts with subclinical hyperthyroidism (normal free T4 and decreased TSH) and without thyroid dysfunction. We assessed outpatient prescription (surveillance vs. radioactive iodine or antithyroid drugs) and thyroid function evolvement. Results: 475 pts were included; 71 (14.9%) had subclinical disease. Subclinical hyperthyroidism (n = 38) vs. pts without thyroid dysfunction (n = 404): men 39.5% vs. 46.5% (ns), age 79 ± 14.8 vs. 73 ± 14.9 years old (p = 0.022), and atrial fibrillation (AF) 26.3% vs 28.9% (ns); HR at admission 85.4 ± 20.2 vs. 84.4 ± 22.9 ppm (ns), systolic arterial pressure 143.5 ± 31.5 vs. 135.1 ± 29.2 mm Hg (p = 0.098), and BMI 26.1 ± 4.8 vs. 26.6 ± 5.6 (ns). 27.8% of pts with subclinical hyperthyroidism were on prior therapy with amiodarone. In-hospital mortality is 18.4 vs. 4.9% (p = 0.001) and long-term mortality is 16.1 vs. 14.6% (ns). On follow-up, from the 31 pts with hyperthyroidism, 80.6% evolved to euthyroidism, 12.9% to subclinical hyperthyroidism and 6.5% to clinical hyperthyroidism. At discharge, only one patient, who evolved to euthyroidism, was prescribed an antithyroid drug. Conclusion: Patients with hyperthyroidism are significantly older and have significantly higher in-hospital mortality than pts without thyroid dysfunction. Even without directed therapy, most evolved to normal thyroid function. The favorable long-term prognosis supports our conservative attitude.