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Do not treat subclinical hypothyroidism in most patients
Clinical Question
Should adults with subclinical hypothyroidism be treated?
Bottom line
Based on good evidence, this group strongly recommends against treating patients with no symptoms or vague symptoms, thyroid-stimulating hormone levels 10 mIU/L to 20 mIU/L, and normal thyroxine levels. These guidelines may not apply to adults younger than than 30 years or to women at risk of unplanned pregnancy. 1a
Reference
Study design: Practice guideline
Funding: Self-funded or unfunded
Setting: Various (guideline)
Synopsis
This guideline is based on a systematic review of 21 studies of 2192 participants. The developers evaluated the effect of treatment on quality of life, symptoms, and mortality, focusing on adults older than 30 years. The guideline developers were an ad hoc group of methodologists, general practitioners, endocrinologists, and patients with subclinical hypothyroidism—in other words, the guidelines don't come from a professional society. No members had financial conflicts of interest. The group used the GRADE approach to create the recommendations. Based on moderate to high quality evidence, thyroid supplementation, as compared with placebo, has no effect on quality of life or symptoms. The quality of evidence on cardiovascular events or mortality is low and the results are short-term, but there also doesn't seem to be any effect of treatment on those outcomes.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA