Should we treat subclinical hypothyroidism?

doi:10.1136/bmj.a834

Published 16 July 2008, doi:10.1136/bmj.a834
Cite this as: BMJ 2008;337:a834

Practice

Uncertainties Page

Should we treat subclinical hypothyroidism?

Cung B Pham, clinical instructor¹, Allen F Shaughnessy, professor¹

¹ Department of Public Health and Family Medicine, Tufts University School of Medicine, Tufts University Family Medicine Residency at Cambridge Health Alliance, Malden, Massachusetts, USA

Correspondence to: A F Shaughnessy, PharmD, Tufts University Family Medicine Residency, 195 Canal Street, Malden, MA 02148 Allen.Shaughnessy@Tufts.edu

The first 150 words of the full text of this article appear below.

Subclinical hypothyroidism is a laboratory definition: a raisedconcentration of thyroid stimulating hormone (TSH) yet a normalconcentration of free thyroid hormone, without specific symptomsof thyroid dysfunction. Patients with subclinical hypothyroidismhave an increased risk of progressing to overt hypothyroidism.Yet uncertainty exists as to the benefits of treating such patients.

Recent systematic reviews of cohort studies have shown a significantincrease in coronary heart disease and cardiovascular relatedmortality in people with subclinical hypothyroidism and a TSHconcentration >10 mU/l, but no difference in overall mortality.¹² The benefits of treating subclinical hypothyroidism are alsouncertain: although two systematic reviews have suggested thattreatment may decrease total cholesterol and low density lipoproteincholesterol levels, particularly in people with TSH concentrationsof >10 mU/l,³ ⁴ no research has shown a decrease in coronaryheart disease or mortality with treatment.

The Clinical Evidence review reports mixed results from smallrandomised controlled trials . . . [Full text of this article]

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