Treatment options of subclinical hyperthyroidism and cardiovascular risk

Subclinical hyperthyroidism (SCH) is common and is characterized by laboratory findings of a persistently low TSH level and normal FT4 and FT3 values. The interpretation of studies on the clinical significance of SCH have been complicated by the fact that the degree and etiology of SCH varies, but research has suggested that it is associated with osteoporosis, weight changes, adverse cardiovascular effects including an increased risk of atrial fibrillation, and an increased all-cause mortality rate. We discuss SCH and review the literature on its suspected cardiovascular effects, which are more likely to be seen in the elderly and in patients with more significant degrees of TSH suppression. We then discuss SCH treatment options in detail and suggest an algorithm for the management of SCH that takes into consideration the TSH level and the presence of clinical risk factors.SCOPUS: re.j