Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefits
Subclinical hypothyroidism (SCH) is defined as elevated thyroid stimulating hormone (TSH) with normal levels of free triiodothyronine (FT3) and free thyroxine (FT4). SCH is further classified into a milder condition with TSH levels between 4.0 and 10.0 milli-international units (mIU)/l (mild-SCH) an...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2016-02-01
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| Series: | Therapeutic Advances in Endocrinology and Metabolism |
| Online Access: | https://doi.org/10.1177/2042018815616543 |
| _version_ | 1819008250796834816 |
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| author | Zeeshan Javed Thozhukat Sathyapalan |
| author_facet | Zeeshan Javed Thozhukat Sathyapalan |
| author_sort | Zeeshan Javed |
| collection | DOAJ |
| description | Subclinical hypothyroidism (SCH) is defined as elevated thyroid stimulating hormone (TSH) with normal levels of free triiodothyronine (FT3) and free thyroxine (FT4). SCH is further classified into a milder condition with TSH levels between 4.0 and 10.0 milli-international units (mIU)/l (mild-SCH) and a severe form with TSH >10.0 mIU/l (severe-SCH). SCH is a common problem (prevalence is greater in women than men), which increases further with increasing age and TSH levels. Even though the risk of progression to overt hypothyroidism is higher in patients with severe-SCH, the risk is also significant in patients having mild-SCH; it has been suggested that every twofold rise in serum TSH would increase the risk from 1 to 4%, which further increases to 38% if thyroid antibodies are positive. Current data have shown increased cardiovascular risk in patients with mild-SCH and have demonstrated some benefits of levothyroxine treatment in reducing these events. However, evidence on the association of mild-SCH and musculoskeletal system, cognitive dysfunction, mood disorders, dyslipidaemia, diabetes and goitre is conflicting. Similarly, the discussion regarding the exact upper limit of normal for serum TSH remains controversial. The data have also shown increased risk of adverse pregnancy outcomes in patient with mild-SCH, with some benefits of thyroxine treatment. The recent available guidelines related to management of patients with serum TSH <10 mIU/l have suggested decisions should be made taking into account the age of the patient, associated risk factors and comorbid conditions. This chronicle review assesses current evidence regarding the risks associated and the recommendations related to benefits of levothyroxine treatment in patients having mild-SCH. |
| first_indexed | 2024-12-21T00:37:30Z |
| format | Article |
| id | doaj.art-5b592a31afdc45f69decd1f3fe88823f |
| institution | Directory Open Access Journal |
| issn | 2042-0188 2042-0196 |
| language | English |
| last_indexed | 2024-12-21T00:37:30Z |
| publishDate | 2016-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Endocrinology and Metabolism |
| spelling | doaj.art-5b592a31afdc45f69decd1f3fe88823f2022-12-21T19:21:46ZengSAGE PublishingTherapeutic Advances in Endocrinology and Metabolism2042-01882042-01962016-02-01710.1177/2042018815616543Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefitsZeeshan JavedThozhukat SathyapalanSubclinical hypothyroidism (SCH) is defined as elevated thyroid stimulating hormone (TSH) with normal levels of free triiodothyronine (FT3) and free thyroxine (FT4). SCH is further classified into a milder condition with TSH levels between 4.0 and 10.0 milli-international units (mIU)/l (mild-SCH) and a severe form with TSH >10.0 mIU/l (severe-SCH). SCH is a common problem (prevalence is greater in women than men), which increases further with increasing age and TSH levels. Even though the risk of progression to overt hypothyroidism is higher in patients with severe-SCH, the risk is also significant in patients having mild-SCH; it has been suggested that every twofold rise in serum TSH would increase the risk from 1 to 4%, which further increases to 38% if thyroid antibodies are positive. Current data have shown increased cardiovascular risk in patients with mild-SCH and have demonstrated some benefits of levothyroxine treatment in reducing these events. However, evidence on the association of mild-SCH and musculoskeletal system, cognitive dysfunction, mood disorders, dyslipidaemia, diabetes and goitre is conflicting. Similarly, the discussion regarding the exact upper limit of normal for serum TSH remains controversial. The data have also shown increased risk of adverse pregnancy outcomes in patient with mild-SCH, with some benefits of thyroxine treatment. The recent available guidelines related to management of patients with serum TSH <10 mIU/l have suggested decisions should be made taking into account the age of the patient, associated risk factors and comorbid conditions. This chronicle review assesses current evidence regarding the risks associated and the recommendations related to benefits of levothyroxine treatment in patients having mild-SCH.https://doi.org/10.1177/2042018815616543 |
| spellingShingle | Zeeshan Javed Thozhukat Sathyapalan Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefits Therapeutic Advances in Endocrinology and Metabolism |
| title | Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefits |
| title_full | Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefits |
| title_fullStr | Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefits |
| title_full_unstemmed | Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefits |
| title_short | Levothyroxine treatment of mild subclinical hypothyroidism: a review of potential risks and benefits |
| title_sort | levothyroxine treatment of mild subclinical hypothyroidism a review of potential risks and benefits |
| url | https://doi.org/10.1177/2042018815616543 |
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