Cardiovascular and medical ramifications of treatment of subclinical hypothyroidism.
Subclinical hypothyroidism can be diagnosed in 1% to 10% of the adult population, is more common in women, and increases with age. In many patients, treatment with L-thyroxine reduces low-density lipoprotein cholesterol, improves cardiac function, reduces symptoms of hypothyroidism, and diminishes neuropsychiatric symptoms. Treatment also reduces the likelihood of statin-induced myopathy. However, in double-blind, placebo-controlled trials of L-thyroxine therapy in subclinical hypothyroidism, cardiovascular and symptomatic benefits have been neither uniform nor definitive. In the absence of a large-scale, multicenter, randomized trial, physicians have to individualize therapy for each patient. Benefits of therapy are most likely to be realized in patients with thyroid-stimulating hormone levels greater than 10 mU/L on repeated measures, those with hypothyroid symptoms, those who are pregnant, those with a documented family history of hypothyroidism, and those with severe hyperlipidemia.
Glueck
Charles J
CJ
Cholesterol Center Jewish Hospital, 3200 Burnet Avenue, Cincinnati, OH 45229, USA. glueckch@healthall.com
Streicher
Patricia
P
D000328:Adult; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications / Q000188:drug therapy*; D008297:Male; D009135:Muscular Diseases / Q000139:chemically induced*; D011247:Pregnancy; D013974:Thyroxine / Q000009:adverse effects* / Q000627:therapeutic use*
D013974:Thyroxine