Hypothyroidism - Treatment

Treatment

A variety of factors affect the decision of whether to treat a patient for hypothyroidism, which dosage to begin with, and how rapidly treatment should be started or increased:

• First, an elevated TSH (thyrotropin) level should be confirmed and thyroxine (T4) level determined. Other thyroid tests may also be helpful.
• Measuring cholesterol levels is also important.

Doctors should also consider:

• Age of the patient
• Presence of other medical problems that may benefit from thyroid replacement treatment (such as heart failure or depression)
• Presence of other medical problems that thyroid replacement therapy may worsen (such as osteoporosis)

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Treating Overt Hypothyroidism. Patients with overt hypothyroidism, indicated by clear symptoms and blood tests that show high TSH (generally 10 mU/L and above) and low thyroxine (T4) levels, must have thyroid replacement therapy.

Treating Subclinical or Mild Hypothyroidism. Considerable debate exists about whether to treat patients with subclinical hypothyroidism (slightly higher than normal TSH levels, normal thyroxine levels, and no obvious symptoms). Some doctors opt for treatment and others opt for simply monitoring patients.

It is not clear if the benefits of treating subclinical hypothyroidism outweigh the risks and potential complications. Doctors who recommend against treatment argue that thyroid levels can vary widely, and subclinical hypothyroidism may not persist. In such cases, overtreatment leading to hyperthyroidism is a real risk.

There is reasonable evidence and consensus to recommend treatment for subclinical hypothyroidism in the presence of other factors, including:

• High total or LDL cholesterol levels
• Blood tests that show autoantibodies indicating a future risk for Hashimoto's thyroiditis or other forms of other autoimmune hypothyroidism
• Blood tests that show TSH levels greater than 10 mU/L
• Goiter
• Pregnancy
• Female infertility associated with subclinical hypothyroidism

Treatment is optional in patients with subclinical hypothyroidism who have no obvious symptoms and normal cholesterol levels. Some doctors feel that treating this group of patients will prevent progression to overt hypothyroidism and future heart disease, as well as increase a patient's sense of well-being. However, the evidence to support treatment of this patient group is not nearly as strong. Many doctors recommend against treatment and suggest that these patients should simply have lab tests every 6 - 12 months.