0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Treatment of Borderline Elevated Thyrotropin Levels

Oscar M. P. Jolobe, MRCP(UK), DPhil1
[+] Author Affiliations
1Manchester Medical Association, Manchester, England
JAMA Intern Med. 2015;175(3):466. doi:10.1001/jamainternmed.2014.7847.
Text Size: A A A
Published online

Extract

To the Editor Over and above the substantial risk of developing a suppressed thyrotropin level following replacement therapy,1 there is a risk that thyroid replacement therapy may precipitate transition to persistent atrial fibrillation (AF), with all its attendant sequelae, when replacement therapy is administered to patients with unrecognized paroxysmal AF (PAF).

It is already recognized that a substantial minority of subclinically hypothyroid patients have coexisting AF,25 which may escape detection either because of inadequate checks or, alternatively, because it is paroxysmal in nature.5 In a study that evaluated 2639 US community-dwelling individuals 65 years or older with baseline thyrotropin levels, 496 had subclinical hypothyroidism characterized by thyrotropin levels in the range 4.5 mU/L to just below 20 mU/L. Among those subclinically hypothyroid patients, 24 (4.8%) had coexisting AF.2 In a Canadian study that evaluated 707 patients with recent (<3 months) onset of documented AF, 56 patients (mean age, 66.6 years) were identified as having an elevated thyrotropin level that was lower than 20 mU/L.3

Topics

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

March 1, 2015
Susan S. Braithwaite, MD; Justin B. Moore, MD
1Division of Endocrinology, Department of Internal Medicine, University of Illinois at Chicago
2Department of Internal Medicine, University of Kansas School of Medicine–Wichita
JAMA Intern Med. 2015;175(3):465-466. doi:10.1001/jamainternmed.2014.7841.
March 1, 2015
Peter N. Taylor, MSc, MRCP; Onyebuchi E. Okosieme, MD, FRCP; Colin M. Dayan, PhD, FRCP
1Thyroid Research Group, Institute of Molecular Medicine, Cardiff University School of Medicine, Cardiff, Wales
JAMA Intern Med. 2015;175(3):466-467. doi:10.1001/jamainternmed.2014.7862.
CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

174 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Jobs
brightcove.createExperiences();