ETA Guideline: Management of Subclinical Hypothyroidism

Subclinical hypothyroidism (SCH) should be considered in two categories according to the elevation in serum thyroidstimulating hormone (TSH) level: mildly increased TSH levels (4.0–10.0 mU/l) and more severely increased TSH value (>10 mU/l). An initially raised serum TSH, with FT 4 within reference range, should be investigated with a repeat measurement of both serum TSH and FT 4 , along with thyroid peroxidase antibodies, preferably after a 2to 3-month interval. Even in the absence of symptoms, replacement therapy with L -thyroxine is recommended for younger patients (<65–70 years) with serum TSH >10 mU/l. In younger SCH patients (serum TSH <10 mU/l) with symptoms suggestive of hypothyroidism, a trial of L -thyroxine replacement therapy should be considered. For such patients who have been started on L -thyroxine for symptoms attributed to SCH, response to treatment should be reviewed 3 or 4 months after a serum TSH within reference range is reached. If there is no improvement in symptoms, L -thyroxine therapy should generally be Received: September 26, 2013 Accepted: October 7, 2013 Published online: November 27, 2013 Prof. Simon Pearce Newcastle University Institute of Genetic Medicine International Centre for Life, Central Parkway Newcastle upon Tyne NE1 3BZ (UK) E-Mail simon.pearce @ ncl.ac.uk © 2013 European Thyroid Association Published by S. Karger AG, Basel 2235–0640/13/0024–0215$38.00/0