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Is the treatment of subclinical hypothyroidism beneficial?

Nature Clinical Practice Endocrinology & Metabolism volume 5, pages 86–87 (2009)Cite this article

Subclinical hypothyroidism is defined as an elevated serum TSH concentration in the presence of serum thyroid-hormone concentrations within the population-based reference range. Clinical symptoms are usually very vague or even absent, and are often not specific to hypothyroidism. Diagnosis is, therefore, entirely dependent on laboratory methods and on the performance of assays used in different laboratories. Serum TSH is the most sensitive parameter with which to screen for thyroid dysfunction in a healthy population, because of the logarithmic-linear relationship between TSH and free T4: even small changes in T4 concentrations result in large changes in serum TSH concentrations.1 Intraindividual variation in the concentration of serum thyroid hormones is much smaller than the population-based reference range. As a consequence, it is hardly surprising that conditions associated with a free T4 level within the population-based reference range—but that are abnormally low for that particular individual—result in a compensatory rise in serum TSH concentrations.2,3

Thyroid dysfunction is often found in elderly individuals. A 12–15% prevalence of subclinical hypothyroidism was reported for a healthy, US-based population aged over 65 years, with a female preponderance.4 Differential diagnoses include Hashimoto thyroiditis, medications, nonthyroidal illness, recovery phase of subacute thyroiditis, TSH resistance, germline mutation of the TSH receptor, thyroid-hormone resistance, TSH-producing pituitary tumor, and effects of radioiodine therapy or thyroid surgery. Furthermore, the presence of heterophilic antibodies can result in a falsely elevated serum TSH concentration.

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  1. Department of Medical Endocrinology PE 2132, Rigshospitalet, Copenhagen University, Blegdamsvej 9, DK–2100 Copenhagen, Denmark ufeldt@rh.dk

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  1. U Feldt-Rasmussen is Chief of the Department of Medical Endocrinology at Rigshospitalet, Copenhagen, Denmark.,

    Ulla Feldt-Rasmussen

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  1. Ulla Feldt-Rasmussen
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Feldt-Rasmussen, U. Is the treatment of subclinical hypothyroidism beneficial?. Nat Rev Endocrinol 5, 86–87 (2009). https://doi.org/10.1038/ncpendmet1049

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