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Review
. 2020 Jan 19;56(1):40.
doi: 10.3390/medicina56010040.

To Treat or Not to Treat Subclinical Hypothyroidism, What Is the Evidence?

Jan Calissendorff  1   2 , Henrik Falhammar  1   2
Affiliations
Review

To Treat or Not to Treat Subclinical Hypothyroidism, What Is the Evidence?

Jan Calissendorff et al. Medicina (Kaunas). .

Abstract

Objective: levothyroxine prescriptions have increased remarkably during the last decade, and it is most likely to be prescribed in subclinical hypothyroidism. The aim of this review was to present data on when levothyroxine treatment should be initiated, and the effects of treatment in subclinical hypothyroidism on symptoms such as weight, quality of life, vitality, cognition, and cardiovascular disease. We also discuss evidence for different thyroid-hormone medications. In addition, the option to withhold medication when there is uncertain diagnosis or lack of clinical improvement is discussed.

Methods: a literature search in PubMed on the term "treatment of subclinical hypothyroidism" in combination with "quality of life", "weight", "cognition", and "cerebrovascular disease".

Results: current research supports that levothyroxine should be initiated in patients with a thyroid stimulating hormone (TSH) >10 mIU/L. Treatment for hypothyroidism is becoming more frequent. Symptoms related to vitality, weight, and quality of life in subclinical disease often persist with levothyroxine treatment, and other causes should be explored. Patients with cardiovascular-risk factors may benefit from treatment, especially younger patients. Caution is necessary when treating elderly subjects with levothyroxine.

Conclusion: lifelong treatment with levothyroxine should normally only be considered in manifest hypothyroidism. However, in subclinical hypothyroidism with a TSH >10 mIU/L, therapy is indicated. In milder subclinical forms, a wait-and-see strategy is advocated to see if normalization occurs. Subgroups with cardiovascular risk and subclinical hypothyroidism may benefit from levothyroxine therapy.

Keywords: levothyroxine; overtreatment; subclinical hypothyroidism.

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Conflict of interest statement

These authors declare no conflict of interest.

References

    1. Jonklaas J., Bianco A.C., Bauer A.J., Burman K.D., Cappola A.R., Celi F.S., Cooper D.S., Kim B.W., Peeters R.P., Rosenthal M.S., et al. Guidelines for the treatment of hypothyroidism: Prepared by the american thyroid association task force on thyroid hormone replacement. Thyroid. 2014;24:1670–1751. doi: 10.1089/thy.2014.0028. - DOI - PMC - PubMed
    1. Garber J.R., Cobin R.H., Gharib H., Hennessey J.V., Klein I., Mechanick J.I., Pessah-Pollack R., Singer P.A., Woeber K.A., American Association of Clinical Endocrinologists et al. Clinical practice guidelines for hypothyroidism in adults: Cosponsored by the american association of clinical endocrinologists and the american thyroid association. Endocr. Pract. 2012;18:988–1028. doi: 10.4158/EP12280.GL. - DOI - PubMed
    1. Pearce S.H., Brabant G., Duntas L.H., Monzani F., Peeters R.P., Razvi S., Wemeau J.L. 2013 eta guideline: Management of subclinical hypothyroidism. Eur. Thyroid J. 2013;2:215–228. doi: 10.1159/000356507. - DOI - PMC - PubMed
    1. Almandoz J.P., Gharib H. Hypothyroidism: Etiology, diagnosis, and management. Med. Clin. N. Am. 2012;96:203–221. doi: 10.1016/j.mcna.2012.01.005. - DOI - PubMed
    1. Baumgartner C., Blum M.R., Rodondi N. Subclinical hypothyroidism: Summary of evidence in 2014. Swiss Med. Wkly. 2014;144:w14058. doi: 10.4414/smw.2014.14058. - DOI - PubMed