Given the conflicting evidence, what should physicians do?
Yes. If you look at all the evidence we have, the younger the patient who has subclinical hypothyroidism, the more likely it is to be something you would want to treat. And although the studies are conflicting, those that show increased CV risk or adverse CV outcomes seem to be confined to studies looking at younger or middle-aged people, not older persons. By the same token, if you take studies that look at older people, those are the studies that don’t really show any difference in people’s health if they have subclinical hypothyroidism or if they are normal. And the most extreme case is the example of extremely old people, those who are over 85 years of age. If you divide them according to those with normal thyroid function and those with subclinical hypothyroidism, it turns out that the people with subclinical hypothyroidism live longer than the normal people. So there’s sort of a spectrum here: subclinical hypothyroidism seems to be a more significant problem in younger or middle-
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