Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Subclinical hypothyroidism has a prevalence of approx. 6% in the general population; it is more common in females and in the elderly. The incidence of progression to overt hypothyroidism is 5-15% per year; women with positive thyroid antibodies are especially at risk. The biological significance appears to be small; there may be an association with depression. Subclinical hypothyroidism does not cause significant hypercholesterolaemia. Thyroxine treatment results in improvement of symptoms in 25-30%. Subclinical hyperthyroidism has a prevalence of approx. 1%; it is also more common in older age groups, but its female preponderance is less marked. The incidence of progression to overt thyrotoxicosis is approx. 5% per year; subjects with autonomous thyroid adenoma or nodular goitre are especially at risk. The biological significance appears to be small. Bone density is slightly reduced in cortical bone (radius and femoral neck) but not in trabecular bone (lumbar spine). There might be an association with atrial fibrillation, which is possibly more likely to convert to stable sinus rhythm after antithyroid treatment. In view of the high prevalence of subclinical hypothyroidism and hyperthyroidism one might consider screening programs in the general population, which are feasible by the availability of an appropriate screening test (the sensitive TSH assay) and effective treatment. Such screening programs, however, are not justified at the present time because (a) the associated burden of disease is small and (b) it has not been proven beyond doubt that early diagnosis and treatment in the asymptomatic phase improves clinical outcome. A high degree of suspicion of thyroid function disorders is, however, warranted, especially in females over 40 years presenting with non-specific complaints.
 ...
PMID:Subclinical hypothyroidism and hyperthyroidism. I. Prevalence and clinical relevance. 776 Sep 71

Subclinical thyroid dysfunction is characterized by normal levels of thyroid hormones but abnormal values of thyrotropin (TSH) in an asymptomatic individual. Subclinical hypothyroidism is a common disorder with a prevalence of about 7 to 8% in women (most frequently in females over 50 years), and about 3% in men. It is characterized by elevated serum TSH in the presence of normal concentrations of serum thyroxine. Patients with TSH levels about 12 mU/L (and with positive antithyroidal antibodies) have the highest risk for developing overt hypothyroidism. Therefore, these patients will require L-thyroxine treatment. In patients with TSH < 12 mU/L, the indication for therapy depends on the etiology, on risk factors and concomitant diseases (e.g. strumectomy, coronary heart disease, depression, infertility). Subclinical hyperthyroidism (TSH suppression syndrome) is characterized by normal thyroid hormone concentrations but diminished serum TSH. Most frequently, this disorder is caused by exogenous L-thyroxine treatment. The endogenous form of subclinical hyperthyroidism mainly caused by nodular goiter has a prevalence of up to 20% in patients with large goiters. In patients with subclinical hyperthyroidism, there is an increased risk for development of atrial fibrillation and for a decrease in bone mass in postmenopausal women. In the majority of patients measurable TSH levels can be detected before or after stimulation with TRH. This formally excludes overt hyperthyroidism in such patients. Frequently, there is no need for treatment but follow-up is important. However, in patients with subclinical hyperthyroidism associated with atrial fibrillation a therapy with antithyroid drugs, beta-blockers or radioiodine must be considered.
 ...
PMID:[Is there a need for treatment in subclinical hypo- and hyperthyroidism?]. 1043 73

Thyroid gland ultrasonography is recommended in patients with nonspecific clinical symptoms such as fatigue, weight gain, dry skin, amnesic symptoms, depression, bradycardia, abnormal myocardial contractility, increased diastolic pressure, hypercholesterolemia, menstrual abnormalities, infertility, fibrocystic breast disease, anxiety, insomnia, tachycardia, paroxysmal atrial fibrillation and osteoporosis. Subclinical hypothyroidism or hyperthyroidism can cause any of the above mentioned symptoms. Diffusely decreased, decreased and inhomogenous thyroid gland echogenicity requires laboratory examination. Thyroid gland ultrasonography is recommended also in patients with type I. diabetes mellitus and vitiligo because of increased incidence of thyroid disorders in these patients. Clinical observation of patients treated with Lithium, Amiodaron or Interferon is also recommended. (Tab. 2, Fig. 6, Ref. 18.)
 ...
PMID:Contribution of thyroid gland ultrasound for screening of patients with suspected subclinical thyroid gland disorders. 1091 42

Subclinical hypothyroidism is associated with aspecific complaints such as tiredness, cognitive and depressive complaints, subtle disturbances in lipid values, an increased risk of cardiovascular disease, ovulatory dysfunction and a negative effect on foetal psychomotor development and pregnancy outcome. Subclinical hyperthyroidism is associated with atrial fibrillation, osteoporosis and dementia. Not enough prospective randomised studies with hard outcomes are available to provide evidence-based general recommendations. Therefore, the decision as to whether or not a patient should be treated needs to be made on an individual basis. For subclinical hypothyroidism it is advisable to consider treatment in the case of positive thyroid peroxidase antibody tests, a TSH concentration higher than 10 mU/l, the presence of one or more risk factors for cardiovascular disease, infertility on the basis of ovulatory dysfunction, and pregnancy. In the case of complaints of tiredness and certainly in the case of depression or cognitive dysfunction, a 3-month trial treatment can be considered. This leads to a decrease of the complaints in about 25% of cases. As negative effects are associated with the treatment, we advise an expectant approach in all other cases with a yearly monitoring of the TSH concentration. For subclinical hyperthyroidism it is advisable to consider treatment in the case of a nodular goitre, and especially in the case of atrial fibrillations. If subclinical hyperthyroidism persists in the absence of nodular thyroid disease, an expectant approach appears to be justified.
 ...
PMID:[Subclinical functional disorders of the thyroid gland]. 1284 32

The effects of overt hypothyroidism (HO) on cognition and mood are well established, and HO is considered a common cause of reversible dementia. There is now increasing evidence to suggest that subclinical hypothyroidism (ie, elevated thyroid stimulating hormone in the presence of normal thyroxine concentrations) may be a predisposing factor for depression, cognitive impairment, and dementia. Subclinical hypothyroidism is more common than HO and is most prevalent in the elderly, particularly in women. Older adults may be more vulnerable to the effects of subclinical hypothyroidism, given age-related changes to the hypothalamic-pituitary-thyroid axis, and there is an association between thyroid status and cognitive decline and dementia in the elderly. The purpose of this review is to summarize existing data on the cognitive and neuropsychiatric consequences of subclinical hypothyroidism, benefits of treatment, and recommendations for screening and monitoring in older adults.
 ...
PMID:Cognitive and neuropsychiatric aspects of subclinical hypothyroidism: significance in the elderly. 1367 60

Subclinical hypothyroidism is defined as elevated TSH in the presence of normal free T4 and T3 levels. This review discusses the following questions concerning subclinical hypothyroidism that have not been solved yet: 1) does elevated TSH always mean failure of the thyroid gland? 2) Do patients with subclinical hypothyroidism always develop overt hypothyroidism? 3) Are they symptomatic? 4) Does treatment with L-Thyroxine cure these symptoms,--if they exist? Summarizing the results of the literature one can give the following answers: 1) Elevated TSH with normal free T4 can but does not necessarily mean thyroid failure. 2) Patients with positive thyroid antibodies and especially with TSH levels above 10 mU/l are at high risk to develop overt hypothyroidism. 3) Typical symptoms (thyroid-specific, cardiovascular, neurological and psychiatric and finally alterations of risk factors for atherosclerosis) seem to occur in a greatly varying percentage of patients--some of the described symptoms are of questionable clinical importance. 4) Some of the symptoms, especially the cardiovascular, seem to be treatable by L-T4, whereas others like most of the changes in lipid metabolism can not be influenced by normalization of the TSH levels. In conclusion, screening for TSH and free T4 seems to be justified in elderly women, where the prevalence of the disease is approximately 20%. However, treatment of "symptoms" of subclinical hypothyroidism like elevated cholesterol levels or depression should be done only in patients with a TSH > 10 mU/l and there only with great caution in order to avoid unnecessary overdosage with the danger of eliciting atrial fibrillation.
 ...
PMID:[Possible consequences of subclinical hypothyroidism]. 1471 Apr 77

Subclinical hypothyroidism (SHT) and subclinical hyperthyroidism (SCH) are defined as normal serum free T4 and T3 levels associated with elevated (SHT) or subnormal (SCH) serum TSH levels, respectively. Symptoms and signs of thyroid dysfunction are scarce. The prevalence is low. In SHT, total cholesterol and LDL-C are modestly elevated and levothyroxine may influence the lipids levels. There is decreased cardiac contractility and increased peripheral vascular resistance that improve with treatment. SCH is associated with atrial fibrillation, increased cardiac contractility and left ventricular mass, diastolic and systolic dysfunction that can be reversed with beta-adrenergic antagonists. Bone density is reduced in SCH. Depression, panic disorders and alterations in cognitive testing are frequent in SHT. Treatment of SHT is recommended for serum TSH levels greater than 8 mU/L and presence of thyroid antibodies. Endogenous SCH should be treated for serum TSH levels less than 0.1 mU/L, in the presence of symptoms and in elderly patents.
 ...
PMID:[Subclinical thyroid disease: subclinical hypothyroidism and hyperthyroidism]. 1561 27

Subclinical hypothyroidism and/or the presence of thyroid peroxidase antibodies (TPOAb) may be associated with subfertility, infertility, spontaneous abortion, placental abruption, preterm delivery, gestational hypertension, preeclampsia, postpartum thyroid dysfunction, depression (including postpartum depression), and impaired cognitive and psychomotor child development. In November 2002, the American Association of Clinical Endocrinologists (AACE) released new guidelines for clinical practice for the diagnosis and treatment of hyperthyroidism and hypothyroidism, which includes a new thyroid-stimulating hormone (TSH) reference range of 0.3 to 3.0 mIU/L. Recently, the AACE recommended screening all women considering conception and/or all gravid women in the first trimester for thyroid dysfunction. However, the American College of Obstetricians and Gynecologists (ACOG) and the United States Preventive Services Task Force (USPSTF) have not endorsed these recommendations. This article reviews the evidence regarding screening women during pregnancy for subclinical hypothyroidism and/or the presence of thyroid peroxidase antibodies.
 ...
PMID:Clinical controversies in screening women for thyroid disorders during pregnancy. 1664 67

Subclinical hypothyroidism, which is defined as elevated thyroid-stimulating hormone (TSH) levels with free thyroxine concentrations within the reference range, is a common disorder that increases with age and affects up to 18% of the elderly, with a higher prevalence in women compared to men. Prospective data have shown an increased risk of coronary heart disease events, heart failure, and cardiovascular mortality among affected adults. Conflicting results have been found on the association between subclinical hypothyroidism and cognitive impairment, depression and the risk of fractures. Management strategies including screening and treatment of subclinical hypothyroidism are still controversial, while the ongoing European randomised controlled trial "TRUST" targets to solve these uncertainties. This narrative review aims to assess current evidence on the clinical aspects, as well as screening and treatment recommendations in adults with subclinical hypothyroidism.
...
PMID:Subclinical hypothyroidism: summary of evidence in 2014. 2553 49