Raised TSH: to treat or not to treat?
Do you treat people with subclinical hypothyroidism?
You are supposed to, according to current guidelines.
The rationale for treating when serum thyroid stimulating hormone (TSH) is above 10 mIU/l is to alleviate mild symptoms, prevent progression to overt hypothyroidism, and lower cardiovascular risk.
Modest TSH elevations (below 7.0 mIU/l) may not warrant treatment. Large scale randomised clinical trials are needed to determine the effects of L-thyroxine treatment on coronary heart disease and related mortality in people who have subclinical hypothyroidism.
The current position seems to be that TSH levels above 10 mIU/l warrant treatment, levels of 7-10 mIU/l warrant consideration, while with levels below 7 mIU/l it may be justifiable to wait and see.
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Source: Evidence-Based Medicine 2011;16:31-32
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