![Page 1: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/1.jpg)
Welcome to journal club
Subclinical Hypothyroidism
Imran Bashir
![Page 2: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/2.jpg)
Subclinical hypothyroidism • TSH above the limit of reference range when FT4 levels
are normal• Prevalence 4-15%• Prevalence rises with age, higher in females
![Page 3: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/3.jpg)
SH • Can be an incidental finding• Can present with non-specific symptoms of
hypothyroidism like fatigue, constipation• Patients with chronic autoimmune thyroiditis• Prior ablative or anti thyroid drug therapy• Drugs impairing thyroid functions• Most patients with TSH < 10 are asymptomatic• If elevated, should be repeated with FT4 levels
![Page 4: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/4.jpg)
SH: D/D• During period of recovery from nonthyroidal illness• Untreated adrenal insufficiency • TSH producing pituitary adenomas and resistance to
thyroid hormone• Central hypothyroidism
![Page 5: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/5.jpg)
SH: Progress• Spontaneous recovery• Overt hypothyroidism • Cardiovascular risk & neuropsychiatric symptoms
![Page 6: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/6.jpg)
SH: treat or not treat?• TSH values 4.5-10, unlikely to benefit• Those with sign and symptoms and TSH 10-15 likely to
benefit• Treatment in specific group of population
![Page 7: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/7.jpg)
Prospective evaluation of the natural course of idiopathic subclinical hypothyroidism in childhood and adolescence Malgorzata Wasniewska, Mariacarolina Salerno1, Alessandra Cassio2, Andrea Corrias3, Tommaso Aversa, Giuseppina Zirilli, Donatella Capalbo1, Milva Bal2, Alessandro Mussa3 and Filippo De Luca
![Page 8: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/8.jpg)
• Prospective study to evaluate course of SH in children & adolescents
![Page 9: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/9.jpg)
Design • Clinical status, thyroid function, and autoimmunity
evaluated at entry, 6, 12 & 24months in 92 patients with idiopathic SH
![Page 10: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/10.jpg)
• Did the study address a clearly focused issue?
– Yes: prospective study for children with subclinical hypothyroidism
![Page 11: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/11.jpg)
• Did the author use an appropriate method to answer their question?
– Yes: Prospective study is the best way to evaluate the progress
![Page 12: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/12.jpg)
Results• 38 patients normalized their TSH (Group A)
– 16 between 6-12 months– 22 between 12-24 months
• 54 maintained TSH within baseline values (Group B)• 11 exhibited a further increase in TSH (Group C)• No patient showed any signs of hypothyroidism
![Page 13: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/13.jpg)
Results• Majority of patients (88%) normalized or maintained their
TSH• TSH changes were not associated with either FT4
values or clinical status or auxological parameters
![Page 14: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/14.jpg)
• Was the cohort recruited in an acceptable way?
– Yes: appropriate inclusion and exclusion criteria used
![Page 15: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/15.jpg)
• Was the exposure accurately measured to minimize bias?– Yes
• Was the outcome accurately measured to minimize bias?– Yes:
![Page 16: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/16.jpg)
• Confounding factors accounted for?
– Possibly yes• Family history not very well explained
![Page 17: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/17.jpg)
• Was the follow up of subjects long enough?
– Can’t tell: Probably long term follow up is required to see progress of TSH and FT 4
![Page 18: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/18.jpg)
• How precise are the result? And do we believe the results?– Yes: Same laboratory and analyzer used
![Page 19: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/19.jpg)
• Can the results be applied to local population?
– Yes: With same group of subclinical hypothyroid children who don’t have any clinical sign & symptoms or risk factor for thyroid disease.
![Page 20: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/20.jpg)
• Do the results of the study fit with other available evidence?
– Can’t tell: Need more randomized multicenter trials
![Page 21: Welcome to journal club Subclinical Hypothyroidism](https://reader035.vdocument.in/reader035/viewer/2022062501/56816687550346895dda3638/html5/thumbnails/21.jpg)
Thank you….