Selective Therapy of Subclinical Hypothyroidism
Ho-Cheol Kang, MD, PhD
Department of Internal Medicine, Chonnam National University Medical School, Hawsun, Korea
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.- Abstract
- Subclinical hypothyroidism (SCH) is defined by the presence of a raised TSH level but normal circulating free T4 and T3 levels. This condition is a common problem, with an overall prevalence of 4% to 10% in the general population. The fundamental clinical question regarding patients with SCH is whether they should be treated with thyroid hormones. When the TSH is above 10 mIU/L, levothyroxine therapy is generally agreed to be appropriate, however, routine treatment of SCH patients with TSH ranging 4.5∼10 mIU/L has been controversial. With lower TSH levels, individualized therapy may be appropriate. Clinical characteristics of SCH patients who are more likely to benefit from early therapy include high risk of progression to overt hypothyroidism, symptomatic patients, associated cardiovascular risk factors, cardiac dysfunction, pregnancy, infertility, and neuropsychiatric dysfunction. Large-scale randomized studies are needed for the development of uniform recommendations regarding levothyroxine treatment for patients with SCH.
- Keywords : Subclinical hypothyroidism, Therapy
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