title: Subclinical hypothyroidism: an audit of management.
abstract: BACKGROUND
  Subclinical hypothyroidism (SH) is a marker for overt hypothyroidism and vascular disease. Treatment guidelines are not universally followed. Thyroxine is recommended if serum thyroid-stimulating hormone (TSH) concentration is 10 mU/L or more, or if serum TSH is 5-9.9 mU/L (mild SH) with other risk factors, such as thyroid peroxidase antibodies (TPOAb).
  
  
  METHODS
  We examined the management of mild SH in a retrospective case note audit of 150 consecutive subjects. Twenty-seven subjects with a serum TSH concentration above 10 mU/L were excluded from analysis. Of the group with mild SH, 27 were also excluded because of previous thyroid disease or amiodarone therapy.
  
  
  RESULTS
  The prevalence of previous thyroid disease was similar in subjects with TSH 10 mU/L or more, compared to those with mild SH. Overall, both TPOAb and goitre status were determined in only 39% of subjects with mild SH, but in more by endocrinologists compared with general physicians (63% versus 22% for TPOAb; 47% versus 17% for goitre) (P = 0.001). Endocrinologists treated a greater number of subjects with mild SH who were eligible for thyroxine therapy compared to nonendocrine colleagues (96% versus 67%) (P = 0.024). Both groups treated subjects in whom TPOAb status was not determined (endocrinologists 21% versus general physicians 40%) (P = 0.21).
  
  
  CONCLUSIONS
  In subjects with mild SH, evaluation is incomplete, a large percentage who were TPOAb positive were on appropriate therapy, thyroxine was prescribed when TPOAb status was unknown and, on the whole, endocrinologists performed better than general physicians.
authors: Department of Medicine, Caerphilly Miner's Hospital, Caerphilly CF83 2WW, UK.
authors: P K
authors: PK
authors: Prakash
authors: H
authors: H
authors: Bolusani
authors: A
authors: A
authors: Hameed
authors: L D K E
authors: LD
authors: Premawardhana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013960:Thyroid Function Tests
chemical_list: D015415:Biomarkers