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Subclinical hyperthyroidism — SCE Endocrinology MCQ

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HardThyroidSubclinical hyperthyroidismSCE Endocrinology

A 70-year-old man has a suppressed TSH of 0.06 mU/L with normal free T4 and free T3 on repeat testing. He has osteoporosis and paroxysmal atrial fibrillation. There is a multinodular goitre on examination. What is the most appropriate management?

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Correct answer: A — Consider treatment for subclinical hyperthyroidism after specialist assessment

Subclinical hyperthyroidism is clinically relevant in older patients with atrial fibrillation and osteoporosis, particularly with nodular thyroid disease. Levothyroxine would worsen TSH suppression. The pearl is that subclinical biochemical abnormalities can merit treatment when complication risk is high.

Reference: NICE NG145