{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T04:53:40Z","timestamp":1783486420697,"version":"3.55.0"},"reference-count":18,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2016,6,1]],"date-time":"2016-06-01T00:00:00Z","timestamp":1464739200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2016,6]]},"abstract":"\n Background:<\/jats:title>\n There is little information regarding the natural history of subclinical hyperthyroidism (SH) due to Graves' disease (GD).<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A prospective analysis was conducted of patients with SH due to GD between 2007 and 2013 with at least 12 months of follow-up. SH was diagnosed if serum thyrotropin (TSH) was below the laboratory reference range (0.4\u20134.0\u2009mIU\/L) and when thyroid hormones were normal. GD was confirmed by either a raised TSH receptor antibody (TRAb) level or uniform uptake on Technetium scan.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Forty-four patients (89% female, 16% current smokers, and 5% with active Graves' orbitopathy) were diagnosed with SH due to GD. Over the follow-up period (median 32 months), approximately one third (34%) of the cohort progressed to overt hyperthyroidism, one third (34%) normalized their thyroid function, slightly less than one third (30%) remained in the SH state, while one person became hypothyroid. Multivariate regression analysis showed that older age and positive antithyroid peroxidase (TPO) antibody status had a positive association with risk of progression to overt hyperthyroidism, with hazard ratios of 1.06 ([confidence interval (CI) 1.02\u20131.10],\n p<\/jats:italic>\n \u2009<\u20090.01) per year and 10.15 ([CI 1.83\u201356.23],\n p<\/jats:italic>\n \u2009<\u20090.01), respectively, independent of other risk factors including, smoking, TRAb levels at diagnosis, and sex.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n A third each of patients with SH due to GD progress, normalize, or remain in the SH state. Older people and those with positive anti-TPO antibodies have a higher risk of progression of the disease. These novel data need to be verified and confirmed in larger cohorts and over longer periods of follow-up.<\/jats:p>\n <\/jats:sec>","DOI":"10.1089\/thy.2015.0470","type":"journal-article","created":{"date-parts":[[2016,4,18]],"date-time":"2016-04-18T21:58:10Z","timestamp":1461016690000},"page":"765-769","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":19,"title":["The Natural History of Subclinical Hyperthyroidism in Graves' Disease: The Rule of Thirds"],"prefix":"10.1177","volume":"26","author":[{"given":"Sviatlana","family":"Zhyzhneuskaya","sequence":"first","affiliation":[{"name":"Queen Elizabeth Hospital","place":["United Kingdom"]},{"name":"Newcastle University","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Addison","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Tsatlidis","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolanta U.","family":"Weaver","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital","place":["United Kingdom"]},{"name":"Newcastle University","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salman","family":"Razvi","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital","place":["United Kingdom"]},{"name":"Newcastle University","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2016,6,1]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-1231"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.87.2.8182"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-0854"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-2693"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e318187e16d"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2012.04345.x"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2009.03696.x"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.47102\/annals-acadmedsg.V43N10p506"},{"key":"e_1_3_2_10_2","first-page":"277","article-title":"A retrospective study of the natural history of endogenous subclinical hyperthyroidism","volume":"110","author":"Poola R","year":"2011","unstructured":"Poola R, , Mathiason MA, , Caplan RH. 2011. A retrospective study of the natural history of endogenous subclinical hyperthyroidism. WMJ, 110:277\u2013280.","journal-title":"WMJ"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2005.15.687"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2010.03908.x"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-4309"},{"key":"e_1_3_2_14_2","first-page":"168","article-title":"Management of Graves' ophthalmopathy: reality and perspectives","volume":"21","author":"Bartalena L","year":"2000","unstructured":"Bartalena L, , Pinchera A, , Marcocci C. 2000. Management of Graves' ophthalmopathy: reality and perspectives. 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