Medical Health Encyclopedia

In spite of such uncertainties, three out of four major medical organizations recommend treatment for subclinical hypothyroidism, particularly in the following patients with this condition:

• People with high total or LDL cholesterol levels.
• People with blood tests that show autoantibodies indicating a future risk for Hashimoto's thyroiditis or other forms of other autoimmune hypothyroidism.
• People without symptoms but who have blood tests showing TSH levels greater than 10 mU/L.
• People with goiter.
• Pregnant women, regardless of whether they have symptoms, antithyroid antibodies, or high cholesterol.
• Women with infertility that may be associated with subclinical hypothyroidism.

Treatment is optional in patients with subclinical hypothyroidism who have no obvious symptoms and normal cholesterol levels. If they forego treatment, however, they should be tested yearly for TSH and thyroxine.

Treating Patients with Hypothyroidism Symptom and Normal Thyroid Tests. Some doctors treat patients who have a normal or below normal thyroid function test. Some experts believe it is irresponsible to treat such patients with thyroid replacement since such symptoms can occur with many physical and psychological conditions. In any case, well-conducted studies have not found any benefits from T4 replacement therapies in this group.

Thyroid Hormone Replacement

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In the nineteenth century, doctors observed the relationship between myxedema (swelling of the hands, face, feet, and tissues around the eyes) and surgical removal of the thyroid gland. Some doctors, then, began to feed patients with myxedema with whole or powdered extracts of animal thyroid glands. Using thyroid hormone to treat hypothyroidism was one of the first successful medical treatments based on careful scientific observation. With only some modifications, this approach has varied little for over a century.