I have had several persistently elevated TSH levels but I feel fine, and I don want to take thyroid hormone. What are the options?
Patients who feel well but have biochemical evidence for hypothyroidism are classified as having subclinical hypothyroidism (see above). Many of these patients, especially those with positive thyroid antibodies, will later go on to develop symptomatic hypothyroidism and ultimately end up on thyroid hormone. Nevertheless, if the thyroid gland is normal in size, and the patient feels well, another reasonable option is to continue periodically monitoring the situation, without immediately instituting thyroid hormone therapy. Indeed, some patients will continue to have a modest TSH elevation without further progression to significant hypothyroidism, for many years. See Prospective study of the spontaneous course of subclinical hypothyroidism: prognostic value of thyrotropin, thyroid reserve, and thyroid antibodies. J Clin Endocrinol Metab. 2002 Jul;87(7):3221-6.
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