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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.
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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


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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.
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