CC July 2015 Subclinical hypothyroidism

echoecho's version from 2015-10-29 12:29


Question Answer
Define subclinical hypothyroidism?a mildly elevated TSH level with normal free thyroxine (FT4) level
What is the world wide prevalence, making this a relatively common finding?1-10%
Incidence increases with what?age
In patients > 7t years of age, the rate approaches ____% in women and ___% in men?20% ; 6%
*** In 2015, the USPSTF stated that there was _______ (sufficient vs. insufficient) evidence-based data existing to recommend for or against screening of hypothyroidism?insufficient
An updated recommendation is expected in 2015 and what does preliminary information suggest?no change in the recommendation will be forthcoming
50-80% of patients with subclinical hypothyroidism will have antibodies against what?thyroid peroxidase (anti-TPO)
The prevalence of a _____ is twice that seen in the general population?goiter
List those patients that are at increased risk for subclinical hypothyroidism?1) those w/ a hx of neck irradiation 2) those with postpartum thyroiditis 3) those with autoimmune disorders 4) those with exposure to certain medications (amiodarone [Cordarone]; lithium; interferon alfa)
True or false, the majority of subclinical hypothyroidism patients have no risk factors?true
The risk of progression to overt hypothyroidism (low FT4) varies with patient _______?characteristics
List the patients with a higher risk to progression to overt hypothyroidism?1) pts with detectable antithyroid antibodies AND /OR 2) a TSH > 10
True or false, younger women are more likely to progress the overt hypothyroidism than older women?false (older women are more likely to progress than younger women)
About ____% of women with anti-TPO (antibodies against thyroid peroxidase) will develop overt disease within 5 years? What % will develop overt hypothyroidism in 20 years?25%; 60%
How often should lab surveillance be considered (however, no specific recommemndations regarding the optimal frequency or components of surveillance have been developed)?annual
Interventional trials of thyroid hormone replacement in subclinical hypothyroidism have investigated the prevention of progression to overt hypothyroidism, improvement of serum lipids and cardiovascular risk, as well as the impat on the feeling of well-being. What has been the conclusion?there is insufficient data to recommend for or against treatment with levothyroine as a means of preventing or delaying the development ofovert hypothyroidism in patients with mild to moderate elevations of TSH (<10)
Comment on the correction of hypothyroidism in subclinical hypothyroidism as it pertains to lipids?since subclinical hypothyroidism is associated with elevated lipid levels, correction of hypothyroidism leads to trends (not statistically significant) toward improvement of lipid profile.
Correlate the level of TSH to improvement of lipid levels?those with higher TSH levels are more likely to have significant improvement in their lipid levels
True or false, controversy exists regarding the risks of cardiovascular disease in pts with subclinical hypothyroidism, and evidence-based recommendations await randomized studies of significant magnitude?true
What is difficult to document as to improvement in which symptoms?fatigue, depression, weight gain, cognition
Studies have failed to demonstrate consistent ____ from therapy?benefit
Does Levothyroxine therapy to treat pregnant euthyroid women with antithyroid antibodies reduce pre-eclampsia significantly? What did it dono; but it did significantly reduce preterm births by 72%
Why does the American College of Obstretricians and Gynecologists recommend against routine screening for subclinical hypothyroidism?because of limited available data
*** SUMMARY - 50-80% of patients will have antibodies against what? What is the prevalence of a goiter compared to the general population?1) thyroid peroxidase (anti-TPO) 2) twice
*** SUMMARY - List the 2 conditions that put a subclinical hypothyroidism patient at a higher risk for progression?1) detectable antithyroid antibodies AND/OR 2) Tsh > 10
*** SUMMARY - Is there sufficient data to recommend for or against treatment w/ Levothyroxine as a means of preventing or delaying the development of overt hypothyroidism?no
*** SUMMARY - Are there studies that demonstrate consistent benefit from therapy?no