Subclinical Hypothyroidism 101: When to Treat?
Diagnose and treat early to avoid hypothyroidism and to prevent goiter and nodule and thyroid cancer.
Recent editorial in the NEJMed page 1404 October 5 2017 discusses pros and cons of treatment.
- Clearly if there are thyroid antibodies, TPO or TG ab the patient needs thyroid hormone even if the TSH is still upper normal.
- Ultrasound has been used to diagnose Hashimoto’s, CHT in the face of negative antibodies.
- 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.
- Waiting for more significant findings before treatment is a set up for nodular goiter growth and thyroid cancer.
- 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.
- Richard Guttler MD,FACE ECNU