Subclinical Hyperthyroidism: Should We Treat or Merely Observe?

Abstract

Subclinical hyperthyroidism is defined by a persistently low thyroid stimulating hormone with normal thyroxine and triiodothyronine levels. Epidemiological studies report a prevalence of around 3%, with 50% of these patients taking levothyroxine. Misleading entities like pituitary or hypothalamic disease, sick euthyroid syndrome and pregnancy, must be ruled out before establishing the diagnosis. In the absence of any unanimously agreed concensus, the ideal approach to its management has been a matter of debate among endocrinologists. The treatment is decided according to the etiology, severity and potential risks of the patient. A step wise approach should be followed for treatment, viz, i: confirmation of diagnosis, ii: evaluation of severity, iii: investigation of the cause, iv: assessment of potential complications, v: if necessary, selection of appropriate treatment. In conclusion, subclinical hypothyroidism management requires careful monitoring through regular assessment of thyroid function.