Subclinical hypothyroidism

Question 1

How will the TFT’s appear in someone with subclinical hypothyroidism?

Answer 1

TSH raised but T3, T4 normal

Question 2

What are the chances of someone with subclincial hypothyroidism developing overt hypothyroidism?

Answer 2

2-5% per year
Risk increased if patient has autoantibodies

Question 3

Are patients with subclincial hypothyroidism usually treated?

Answer 3

No

Question 4

When would you consider treating a patient with subclincial hypothyroidism?

Answer 4

TSH level is > 10 mU/L on 2 separate occasions 3 months apart

Question 5

If a patient initially presents with asymptomatic subclincial hypothyroidism, what should you do before offering treatment?

Answer 5

Repeat thyroid function tests in 6 months before treating

Question 6

When might you consider offering someone who is < 65 years, a 6-month trial of levothyroxine?

Answer 6

the TSH level is 5.5 - 10mU/L on 2 separate occasions 3 months apart,and
there are symptoms of hypothyroidism

Question 7

What needs to be excluded in someone presenting with subclinical hypothyroidism?

Answer 7

Exclude causes of transiently suppressed TSH such as medication (e.g. steroids, lithium, anti-Parkinson’s medications).

Question 8

What can cause a transiently suppressed TSH?

Answer 8

Steroids, lithium, anti-Parkinson’s medications