Subclinical hypothyroidism: Should we treat?

2.50
Hdl Handle:
http://hdl.handle.net/11287/620342
Title:
Subclinical hypothyroidism: Should we treat?
Authors:
Redford, C.; Vaidya, Bijay
Abstract:
Subclinical hypothyroidism (also known as compensated hypothyroidism or mild hypothyroidism) is a condition associated with a raised serum concentration of thyroid stimulating hormone (TSH) but a normal serum free thyroxine (FT4). It is common, affecting about 10% of women above the age of 55 years. Autoimmunity is the commonest cause of subclinical hypothyroidism. About 2.5% of patients with subclinical hypothyroidism progress to clinically overt hypothyroidism each year; the rate of progression is higher in patients with thyroid autoantibodies and higher thyroid stimulating hormone levels. However, thyroid function normalises spontaneously in up to 40% cases. Only a small minority of patients with subclinical hypothyroidism have symptoms, and the evidence to support that levothyroxine ameliorate the symptoms in these patients is weak. Subclinical hypothyroidism in younger patients (<65 years) is associated with an increased risk of coronary heart disease, heart failure and cerebrovascular disease. The risk increases with increasing levels of thyroid stimulating hormone, and is particularly high in patients with TSH levels ≥10.0 mu/L. There is lack of evidence from randomised controlled trials as to whether levothyroxine treatment can prevent these risks, although a large observational study of the UK general practice research database has shown that levothyroxine may reduce the risk of coronary heart disease in younger patients (<70 years). Therefore, the decision whether to treat or not to treat subclinical hypothyroidism should be made after careful consideration of the patient's age, the presence of symptoms, the presence of thyroid antibodies and other risk factors such as cardiovascular disease.
Citation:
Subclinical hypothyroidism: Should we treat? 2017:2053369117705058 Post Reprod Health
Publisher:
Taylor & Francis
Journal:
Post reproductive health
Issue Date:
1-Jan-2017
URI:
http://hdl.handle.net/11287/620342
DOI:
10.1177/2053369117705058
PubMed ID:
28406057
Additional Links:
http://journals.sagepub.com/doi/abs/10.1177/2053369117705058?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed
Type:
Journal Article
Language:
en
ISSN:
2053-3705
Appears in Collections:
Diabetes/Endocrine Services; 2017 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorRedford, C.en
dc.contributor.authorVaidya, Bijayen
dc.date.accessioned2017-05-26T11:06:08Z-
dc.date.available2017-05-26T11:06:08Z-
dc.date.issued2017-01-01-
dc.identifier.citationSubclinical hypothyroidism: Should we treat? 2017:2053369117705058 Post Reprod Healthen
dc.identifier.issn2053-3705-
dc.identifier.pmid28406057-
dc.identifier.doi10.1177/2053369117705058-
dc.identifier.urihttp://hdl.handle.net/11287/620342-
dc.description.abstractSubclinical hypothyroidism (also known as compensated hypothyroidism or mild hypothyroidism) is a condition associated with a raised serum concentration of thyroid stimulating hormone (TSH) but a normal serum free thyroxine (FT4). It is common, affecting about 10% of women above the age of 55 years. Autoimmunity is the commonest cause of subclinical hypothyroidism. About 2.5% of patients with subclinical hypothyroidism progress to clinically overt hypothyroidism each year; the rate of progression is higher in patients with thyroid autoantibodies and higher thyroid stimulating hormone levels. However, thyroid function normalises spontaneously in up to 40% cases. Only a small minority of patients with subclinical hypothyroidism have symptoms, and the evidence to support that levothyroxine ameliorate the symptoms in these patients is weak. Subclinical hypothyroidism in younger patients (<65 years) is associated with an increased risk of coronary heart disease, heart failure and cerebrovascular disease. The risk increases with increasing levels of thyroid stimulating hormone, and is particularly high in patients with TSH levels ≥10.0 mu/L. There is lack of evidence from randomised controlled trials as to whether levothyroxine treatment can prevent these risks, although a large observational study of the UK general practice research database has shown that levothyroxine may reduce the risk of coronary heart disease in younger patients (<70 years). Therefore, the decision whether to treat or not to treat subclinical hypothyroidism should be made after careful consideration of the patient's age, the presence of symptoms, the presence of thyroid antibodies and other risk factors such as cardiovascular disease.en
dc.language.isoenen
dc.publisherTaylor & Francisen
dc.relation.urlhttp://journals.sagepub.com/doi/abs/10.1177/2053369117705058?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmeden
dc.rightsArchived with thanks to Post reproductive healthen
dc.subjectWessex Classification Subject Headings::Endocrinologyen
dc.titleSubclinical hypothyroidism: Should we treat?en
dc.typeJournal Articleen
dc.identifier.journalPost reproductive healthen
dc.type.versionIn press (epub ahead of print)en

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