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Serum TSH and serum thyroid peroxidase antibody fluctuate in parallel and high urinary iodine excretion predicts subsequent thyroid failure in a 1-year study of patients with untreated subclinical hypothyroidism

Department of Endocrinology and Medicine, Aalborg Hospital, Aarhus University Hospital, 9000 Aalborg, Denmark

(Correspondence should be addressed to J Karmisholt; Email: jsk{at}rn.dk)

Objective: To explore the possibility of predicting decline or improvement in thyroid function over 1 year, and to investigate the correlations of serum TSH (s-TSH) with hypothyroidism-related symptoms and signs, serum thyroid peroxidase antibody (s-TPO-Ab) and urinary iodine excretion in individual patients with untreated subclinical hypothyroidism (SH).

Design: Monthly repeated measurement study without intervention.

Methods: Twenty-one patients without former thyroid disease who had been identified with s-TSH between 5 and 12 mU/l and normal serum thyroxine (s-T₄) at two occasions were enrolled. Subsequently, 13 monthly measurements of s-TSH, hypothyroidism-related symptoms and signs, serum free T₄, s-TPO-Ab and urinary iodine excretion were performed.

Results: Over the study year, s-TSH increased significantly in 5 patients, 16 had unchanged s-TSH, whereas none improved. From clinical and biochemical inclusion data, it was not possible to predict who would later increase in s-TSH. In individual patients, a highly significant correlation between s-TSH and s-TPO-Ab was found (r=0.37, P<0.0001) and also between s-TSH and urinary iodine excretion (r=0.14, P=0.034). No correlation between s-TSH and clinical symptoms and signs was observed. Time shift showed best correlation between s-TSH and s-TPO-Ab measured at the same time point, whereas urinary iodine excretion correlated best to s-TSH and s-TPO-Ab obtained 1 month later.

Conclusion: At the time of inclusion, it was not possible to identify the 24% of SH patients who would show deterioration in thyroid function over the following year. Impairment in thyroid function varied in parallel with thyroid autoimmunity, whereas high urinary iodine excretion predicted high s-TSH and s-TPO-Ab 1 month later.

This article has been cited by other articles:

				J. Karmisholt, S. Andersen, and P. Laurberg Interval between Tests and Thyroxine Estimation Method Influence Outcome of Monitoring of Subclinical Hypothyroidism J. Clin. Endocrinol. Metab., May 1, 2008; 93(5): 1634 - 1640. [Abstract] [Full Text] [PDF]