A Case Of Sub Clinical Hypothyroidism

You are seeing a 45-year-old female in your office. As part of a routine blood panel, the patient’s TSH is noted to be elevated at 7.2 uIU/mL (0.27–4.20 uIU/mL). She has a normal free T4 and is asymptomatic. The best option is to:

A) Start levothyroxine at a low dose to normalize the TSH.
B) Begin T3 at a low dose.
C) Reassure the patient and have her follow-up for repeat thyroid studies.
D) Begin a workup for central hypothyroidism.
E) Begin methimazole.

Answer:



The correct answer is “C.  "Reassure the patient and have her follow-up for repeat thyroid studies."

Discussion There is convincing evidence that asymptomatic patients with a mildly elevated TSH (generally <10 uIU/mL) and normal free T4 do not benefit from treatment in terms of quality of life, etc. In fact, treated patients tend to have more symptomatic anxiety.
The term for this condition (asymptomatic, TSH between 5 and 10, and normal free T4) is subclinical hypothyroidism.
Follow-up thyroid studies are indicated, although the interval may differ depending on the clinician’s judgment. Of note, many patients will have transient changes in their thyroid hormone levels due to comorbid illness, viral thyroiditis, etc. The thing to do is recheck rather than start treatment.