Subclinical hyperthyroidism: flying beneath the radar? A primary care perspective

This case study discusses the presentation of subclinical hyperthyroidism in an older patient looking at the common differentials and pitfalls in the assessment and management of a subnormal thyroid-stimulating hormone finding.

By Dr Amro Maarouf On 9 Feb 2022 Last updated 14 Nov 2022

Case study A 76-year-old lady presented to her GP relaying a long history of fatigue and sweating. Past medical history included type 2 diabetes, hypertension, chronic kidney disease (CKD) and ischaemic heart disease. Routine bloods revealed an unremarkable full blood count, inflammatory markers, haematinics, glycosylated haemoglobin (HbA1c), bone chemistry and renal function confirming stable CKD3 (eGFR 42ml/min/1.73m2). Thyroid function assessment revealed a thyrotropin (TSH) level below the reference interval (0.17 (0.4 -4.9 mu/L)), although free thyroxine (fT4 -13.0 (9-19 pmol/L)) and free triiodothyronine (fT3 – 4.5 (2.6-5.7 pmol/L)) were within the normal distribution. Her TSH had been previously measured on

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