Should All Patients With Subclinical Hypothyroidism Be Treated With Thyroid Hormone Replacement?
There is consensus for initiating thyroxine replacement therapy in patients with TSH levels higher than 10 mIU/L, even if FT4 is within the normal laboratory range. However, this treatment approach is somewhat controversial, as is whether patients with serum TSH levels between 5 and 10 mIU/L should be treated. The argument in favor of replacement therapy is based on numerous proposed consequences of untreated subclinical hypothyroidism: progression to clinical hypothyroidism, subtle systemic symptoms of hypothyroidism, lipid abnormalities, adverse cardiac end points, cardiac dysfunction, adverse fetal effects and pregnancy outcomes, possible contribution to infertility, neuromuscular dysfunction, psychiatric dysfunction, and cognitive dysfunction. Several investigators have demonstrated subtle cardiovascular dysfunction in patients with subclinical hypothyroidism, but the clinical significance is questionable. To date, studies have not shown an association of subclinical hypothyroidism
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- Should All Patients With Subclinical Hypothyroidism Be Treated With Thyroid Hormone Replacement?