Individual research recommendation details

Recommendation ID

NG145/2

Question

What is the clinical and cost effectiveness of treatment (antithyroid drugs or radioactive iodine) for improving long-term health outcomes for people with subclinical hyperthyroidism?

Any explanatory notes
(if applicable)

Why the committee made the recommendations
Treating subclinical hyperthyroidism
There was no evidence available on treating subclinical hyperthyroidism so the committee used their experience to develop the recommendations. They agreed that treatment might be suitable if subclinical hyperthyroidism is persistent and appears to be caused by intrinsic thyroid disease. However, the committee noted that there is currently no evidence that treatment offers benefits and it can have adverse effects. Overall the committee agreed that treatment decisions should be made with specialist advice. Treatment would be appropriate in those most likely to benefit, in other words those with very suppressed TSH and other features suggesting thyroid disease. The committee also agreed that they could not make specific recommendations about when to treat subclinical hyperthyroidism in children as specialist input would also be needed for this.
Several large population-based observational studies have shown that subclinical hyperthyroidism is associated with an increased risk of atrial fibrillation, osteoporosis, dementia, and death, including death from cardiovascular disease. Although most people with subclinical hyperthyroidism have no symptoms, an important question is whether treatment could improve long-term outcomes (for example, atrial fibrillation and dementia). The committee agreed to make a research recommendation to inform future practice.

Monitoring subclinical thyroid dysfunction
There was no evidence available on monitoring subclinical thyroid dysfunction so the committee based the recommendations on their experience.
The overall aim of these recommendations is to ensure that if the subclinical thyroid dysfunction needs treatment, this will be identified in a timely manner but without subjecting a person to a lot of unnecessary tests.
The committee agreed that for children and young people monitoring may need to be more frequent.

How the recommendations might affect practice
Current practice in managing subclinical hyperthyroidism is variable. Some people are offered antithyroid drugs or radioactive iodine; surgery is very rare. Many people are offered no treatment. The recommendations are likely to reduce inappropriate treatment and to be cost saving.
The recommendations for monitoring subclinical thyroid dysfunction reflect good current practice.
Full details of the evidence and the committee's discussion are in evidence review M: management of subclinical thyrotoxicosis.

Source guidance details

Comes from guidance

Thyroid disease: assessment and management

Number

NG145

Date issued

November 2019

Other details