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Subclinical Hypothyroidism

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Thyroid Disorders

Abstract

Subclinical hypothyroidism, is defined as normal serum levels of FT4 and T3, but mildly elevated serum TSH levels, usually less than 10 mU/L. This represents the mildest form of hypothyroidism and is a consequence of the very sensitive feedback relationship between the thyroid and the pituitary gland. In this situation, a small decrement in thyroid hormone output by the thyroid gland, in which serum T4 levels are still within the normal range, results in a serum TSH level that is elevated, albeit usually less than 10 mU/L.

Whether subclinical hypothyroidism is a significant health problem that warrants therapy is a matter of debate. Some patients may have mild symptoms of hypothyroidism as well as increased lipid levels and other risk factors for atherosclerotic cardiovascular disease. There may be progression to overt hypothyroidism over time, especially if serum levels of antithyroid antibodies are high. On the other hand, most patients are asymptomatic, especially when TSH serum levels are less than 10 mU/L, and the link between atherosclerosis is still controversial.

Subclinical hypothyroidism is usually due to underlying Hashimoto thyroiditis. The major complication of Hashimoto thyroiditis is progressive hypothyroidism. Most patients with Hashimoto thyroiditis initially have a small goiter and subclinical hypothyroidism. This is in contrast to overt hypothyroidism, in which FT4 levels are subnormal. The clinical picture of fully developed myxedema is usually quite clear, but the symptoms and signs of mild or subclinical hypothyroidism may be very subtle or absent. This has led to the recommendation by some professional organizations that screening for hypothyroidism be undertaken, especially in high-risk groups, such as older women where the prevalence is high (up to 20 % in women >age 65), and in pregnant women, where untreated hypothyroidism may cause adverse outcomes in the child.

The treatment of subclinical hypothyroidism is a matter of debate but is often instituted because of (1) mild symptoms; (2) dyslipidemia which could be ameliorated by T4 therapy; and (3) positive antithyroid antibody titers, which predicts a higher chance of progression to overt hypothyroidism over time. Sufficient T4 is given to normalize TSH and allow regression of the goiter.

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Authors and Affiliations

  1. University Diabetes Center, King Saud University, Riyadh, Saudi Arabia

    Asim Hassan FRCP, SCE/MRCP (Diab, Endo)

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  1. Internal Medicine, Al-Mouwasat Hospital, Jubail, Saudi Arabia

    Syed Khalid Imam

  2. School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom

    Shamim I. Ahmad

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Hassan, A. (2016). Subclinical Hypothyroidism. In: Imam, S., Ahmad, S. (eds) Thyroid Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-25871-3_11

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