Abstract
Advances in thyroid disorder diagnosis have created new thyroid disorder categories such as subclinical hyperthyroidism and subclinical hypothyroidism. In the 1980s, immunometric assaying for thyroid stimulating hormone (TSH) emerged and became defined as the most cost-effective test in thyroid disorder screening. The second step in the screening of thyroid disorders is to determine free thyroxine (FT4), and cost-effective methods for its detection are now available. Using TSH and FT4, it is possible to determine four situations: clinical hyperthyroidism, clinical hypothyroidism, subclinical hyperthyroidism and subclinical hypothyroidism. Subclinical hypothyroidism can be a strong indicator of risk for atherosclerosis and myocardial infarction in elderly women. Cardiovascular mortality among Brazilian women is one of the highest in the Western world. The best-known risk factors for cardiovascular diseases are high blood pressure, smoking, diabetes, and hypercholesterolemia. Although these are recognized as primary risk factors, there are other risk factors that could be identified as primordial risk factors. This may be the case for subclinical hypothyroidism. Early detection of thyroid disorders in women over fifty could be a highly cost-effective option in the prevention of cardiovascular disorders among Brazilian women.
Highlights
Advances in thyroid disorder diagnosis have created a new category of thyroid disorders such as subclinical hyperthyroidism and subclinical hypothyroidism
Serum levels of free thyroxine and triiodothyronine are normal, but serum thyrotropin levels are mildly decreased in subclinical hyperthyroidism and mildly elevated in subclinical hypothyroidism
Up until that time, there had not been any good evidence that subclinical hyperthyroidism could be associated with an increased risk of osteoporosis, and this needed to be confirmed in further studies.[23,24]
Summary
Advances in thyroid disorder diagnosis have created a new category of thyroid disorders such as subclinical hyperthyroidism and subclinical hypothyroidism. The American Thyroid Association recommends the screening of women and men aged 35 years or over.[4] The American Association of Clinical Endocrinologists recommends screening among older women.[5] The American College of Pathologists recommends screening for women aged over 50 years who seek medical care and for all geriatric patients upon hospital admission.[6] The American Academy of Family Physicians recommends screening for patients aged over 60 years, independent of gender.[7] The American College of Physicians recommends screening for women aged over 50 years with unspecific complaints.[8,9] In particular, the American College of Obstetrics and Gynecology recommends screening for high risk groups like women with a family history of thyroid or autoimmune diseases, from the age of 20 years onwards, so as to prevent fetal disorders.[10] Discussion of this issue has been considered to be so important that the New England Journal of Medicine recently published two reviews analyzing evidence for the treatment of subclinical hypothyroidism and subclinical hyperthyroidism and their possible complications.[11,12].
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