From the Guidelines
Treatment of subclinical hypothyroidism is generally recommended when TSH levels exceed 10 mIU/L, regardless of symptoms, or when TSH is between 4.5-10 mIU/L with symptoms of hypothyroidism or certain risk factors, as supported by the US Preventive Services Task Force recommendation statement 1.
Key Considerations
- The decision to treat subclinical hypothyroidism should be based on individual patient factors, including symptoms, risk factors, and TSH levels.
- The standard treatment is levothyroxine (T4), with dosage adjustments based on TSH levels to achieve a target range of 0.4-4.5 mIU/L.
- Special consideration for treatment should be given to pregnant women, patients with positive thyroid antibodies, goiter, or cardiovascular risk factors, as these groups may benefit from earlier intervention.
Treatment Approach
- Levothyroxine (T4) is the preferred treatment, with initial dosing typically starting at 25-50 mcg daily for older adults or those with cardiac disease, and 50-100 mcg daily for younger, otherwise healthy patients.
- Dosage should be adjusted every 6-8 weeks based on TSH levels, with the goal of achieving a TSH within the reference range.
- Morning administration on an empty stomach, at least 30-60 minutes before food or other medications, is recommended for optimal absorption.
Monitoring and Follow-up
- TSH levels should be monitored every 6-12 months once stable, and treatment is typically lifelong unless the underlying cause resolves.
- Patients with subclinical hypothyroidism should be monitored for progression to overt hypothyroidism, as well as for potential cardiovascular and other risks associated with untreated hypothyroidism, as noted in the studies 1.