Subclinical Hypothyroidism: Deciding When to Treat

Subclinical Hypothyroidism: Deciding When to Treat

Subclinical Hypothyroidism

However, screening patients for thyroid illness, doctors often find increased thyrotropin-stimulating hormone (TSH) levels in patients whose free thyroxine (T4) levels are not below average. This state, named “subclinical hypothyroidism,” is maximum commonly a primary stage of hypothyroidism. Although the condition may resolve or remain unchanged, overt hypothyroidism develops within a few years in some patients, with low free T4 levels and a raised TSH level. The likelihood that this will happen increases with more significant TSH elevations and detectable antithyroid antibodies. Patients with a definite and high prevalence of thyroid failure and the difficulty of making an early clinical diagnosis in ol persistent TSH elevation should remain considered for thyroid treatment. In a dosage that maintains serum TSH levels within the normal range, Levothyroxine is the preferred therapy in these patients.

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Hypothyroidism is quite common in older persons. In one study, one thyrotropin-stimulating hormone (TSH) levels greater than ten μU per mL (10 mU per L) were found in 7 per cent of women and 3 per cent of men who were 60 to 89 years of age, living active lives in the community (normal range: approximately 0.5 to 4.5 μU per mL [0.5 to 4.5 mU per L

Symptoms of  Hypothyroidism

Clinical suspicion of hypothyroidism may remain delayed in elderly patients because symptoms such as fatigue, constipation, and other early manifestations of thyroid failure may remain attributed to ageing itself. The high prevalence of thyroid letdown and the difficulty of making an early clinical diagnosis in older persons suggest that screening for hypothyroidism might be helpful in this group, especially later a simple test, the serum TSH level, is obtainable.

Recommendations about thyroid screening, however, have been inconsistent. Currently, no organizations recommend routine universal screening. For example, the U.S. Preventive Services Task Force2 has suggested that asymptomatic adults not remain screened because evidence of clinical benefit is insufficient. More recently, some authors3 have recommended testing in women more than 40 years of age and in patients in senior facilities.

Danese and co-workers4 demonstrated through a decision Measurement of serum TSH are generally considered the best screening test for thyroid disease; perfect TSH screening every five years, starting at age 35, was cost-effective because progression to overt hypothyroidism remained prevented, serum cholesterol heights were reduced. Symptoms were relieved with early treatment of hypothyroidism.

Subclinical Hypothyroidism

Measurement of serum TSH remain generally considered the best broadcast test for thyroid disease; increased values usually indicate hypothyroidism, and decreased values indicate hyperthyroidism typically. This test has shown to be both sensitive and specific. However, its very sensitivity may create a dilemma since some patients remain found to have elevated serum TSH levels, suggesting hypothyroidism, but have normal levels of thyroid hormone, whether measured as allowed thyroxine (T4) or free T4 index.

This state—an elevated TSH level with an average free T4 level—is referred to as subclinical hypothyroidism. The term “subclinical” may not be strictly correct since some of these patients may have clinical symptoms, but no better time has remained proposed. The elevation of TSH levels reproduces the sensitivity of the hypothalamic-pituitary axis to small decreases in circulating thyroid hormone; as the thyroid gland fails, the TSH level may rise above the upper limit of normal when the free T4 level has fallen only slightly and is still within the normal range.


Subclinical hypothyroidism remains produced by the equal disorders of the thyroid gland as those that cause overt hypothyroidism. Chief among these is chronic autoimmune thyroiditis (Hashimoto’s disease), commonly associated with augmented titers of antithyroid antibodies. Such as antithyroid microsomal antibodies (antithyroid peroxidase) antithyroglobulin antibodies. This disorder remains suspected when thyroid enlargement remains observed, but antithyroid antibodies may also remain associated with atrophy of the thyroid and hypothyroidism.

An additional common cause of hypothyroidism is the treatment of Graves’ disease. Thyroid letdown is most common after radioactive iodine treatment. But hypothyroidism may eventually occur in 5 to 25 per cent of patients treated with surgery or antithyroid drugs. 6,7 Less common reasons for hypothyroidism include the use of medications such as lithium and amiodarone (Cordarone). Pituitary failure is a cause of secondary hypothyroidism.

Still, since, in this circumstance. The TSH level is low rather than high (and thus the direct cause of the thyroid failure). This condition cannot remain diagnosed with certainty until thyroid hormone levels fall below normal. Subclinical hypothyroidism, as usually clear, would not remain detected.


What happens to patients who remain found to have an elevated TSH level without other findings? In some cases, the TSH level will remain expected if measured again several months later; we would then attribute the initial elevation to laboratory error or. Perhaps, to an episode of still thyroiditis with a transient hypothyroid stage. In other cases, the subclinical hypothyroidism remains unchanged. The third possibility, progression to overt hypothyroidism. Occurs at a rate of about 5 per cent per year in patients with raised TSH levels and detectable antithyroid antibodies. 8 In selected cases (e.g., elderly patients with high titers of antithyroid antibodies). The risk of progression to overt disease may be closer to 20 per cent per year. 9 Consideration of these possible outcomes affects the choice about whether to treat or to detect without treatment.

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