Subclinical Hypothyroidism 101: When to Treat?

Subclinical Hypothyroidism 101: When to Treat?

Subclinical Hypothyroidism 101: When to Treat?

Subclinical Hypothyroidism 101: When to Treat?

Diagnose and treat early to avoid hypothyroidism and to prevent goiter and nodule and thyroid cancer.

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Recent editorial in the NEJMed page 1404 October 5 2017 discusses pros and cons of treatment.

My comments:

  1. Clearly if there are thyroid antibodies, TPO or TG ab the patient needs thyroid hormone even if the TSH is still upper normal.
  2. Ultrasound has been used to diagnose Hashimoto’s, CHT in the face of negative antibodies.
  3. images
  4. If there is a family history first degree relatives with CHT, thyroid antibodies and a neck examination is not screening but case finding with an indication. If there is neck examination findings then an ultrasound is indicated.
  5. p137
  6. Waiting for more significant findings before treatment is a set up for nodular goiter growth and thyroid cancer.
  7. A  4 year old, whose mother had CHT, with normal TSH and positive antibodies was not treated by the PMD, and returned 4 years later hypothyroid, goiter and a papillary thyroid cancer nodule.
  8. Richard Guttler MD,FACE ECNU
  9. thyroid.com
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