Endocrine Abstracts

Subclinical hypothyroidism (SCH), defined as a state of elevated TSH concentrations in the presence of normal free thyroxine and triiodothyronine concentrations, can be mild or severe according to the extent of TSH increase. The disease may be progressive or regressive, while the main cause of SCH is chronic autoimmune thyroiditis. However, treatment of SCH remains controversial, levothyroxine being the treatment of choice. It should be initiated in pregnant women and in patients with goiter and high titers of thyroid antibodies. High serum TSH concentrations (4.5–10 mU/l) are associated with increased cardiovascular risk, especially in patients younger than 65 years old, in whom treatment should be commenced. Once treatment is started, serum TSH needs to be rechecked 2 months later and dosage adjustments made accordingly. The aim is to reach a stable serum TSH in the lower half of the reference range (0.4–2.5 mU/l). A low dose of thyroxine is required in patients with diagnosed coronary artery disease. Recent data question any benefit of treatment in patients older than 65 years, while treatment is usually not recommended in older (above 75 years) and very old (above 85 years) patients. It is advisable to implement a wait-and-see strategy and to carefully follow up patients. Nevertheless, an individual approach and tailored therapy is preferable as we should treat the patient and not the disease. Overzealous therapy is strictly to be avoided.