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INVITED REVIEW |
Department of Clinical and Molecular Endocrinology and Oncology, University of Naples ‘Federico II’, Via S. Pansini 5, 80131 Naples, Italy, 1 Department of Clinical Medicine and Cardiovascular Sciences, University of Naples ‘Federico II’, Naples, Italy, 2 Department of Bio-Morphological and Functional Sciences, University of Naples ‘Federico II’, Naples, Italy, 3 Nuclear Medicine Department, Institut Gustave Roussy, 94805 Villejuif, France and 4 Internal Medicine Department, University ‘La Sapienza’, Rome, Italy
(Correspondence should be addressed to B Biondi; Email: bebiondi{at}unina.it)
Subclinical hyperthyroidism appears to be a common disorder. It may be caused by exogenous or endogenous factors: excessive TSH suppressive therapy with L-thyroxine (L-T4) for benign thyroid nodular disease, differentiated thyroid cancer, or hormone over-replacement in patients with hypothyroidism are the most frequent causes. Consistent evidence indicates that ‘subclinical’ hyperthyroidism reduces the quality of life, affecting both the psycho and somatic components of well-being, and produces relevant signs and symptoms of excessive thyroid hormone action, often mimicking adrenergic overactivity. Subclinical hyperthyroidism exerts many significant effects on the cardiovascular system; it is usually associated with a higher heart rate and a higher risk of supra-ventricular arrhythmias, and with an increased left ventricular mass, often accompanied by an impaired diastolic function and sometimes by a reduced systolic performance on effort and decreased exercise tolerance. It is well known that these abnormalities usually precede the onset of a more severe cardiovascular disease, thus potentially contributing to the increased cardiovascular morbidity and mortality observed in these patients. In addition, it is becoming increasingly apparent that subclinical hyperthyroidism may accelerate the development of osteoporosis and hence increased bone vulnerability to trauma, particularly in postmenopausal women with a pre-existing predisposition. Subclinical hyperthyroidism and its related clinical manifestations are reversible and may be prevented by timely treatment.
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