Subclinical hypothyroidism in community perspective: Treat or not to treat?

Abstract

Subclinical hypothyroidism is a common clinical entity prevalent in the community setting, thyroid hormone testing is one of the most frequently asked investigations, and it also is placed in most health panel tests. It is defined as the value of thyroid-stimulating hormone between 4.5-10mIU/L and normal fT4 and fT3. In community-based studies, the prevalence of subclinical hypothyroidism was observed by nearly 4.4% in males and 7.5–8.5% in females. Prevalence of sub clinical hypothyroidism increases in females with advancing age. There is a gray zone for treating the clinical condition with a TSH value between 4.5-10 mIU/ml. Treatment for subclinical hypothyroidism is also under debate for more than two decades with varying opinions. The main focus of treatment is aimed at one of the following criteria: correction of lipid abnormality, progression to overt hypothyroidism, pregnancy, and other medical conditions. There are different schools of thought for deciding to treat such persons. This review highlights the importance, risk, and benefits of treating such conditions with thyroxin replacement from a community perspective.insufficient data on subclinical hypothyroidism forced medical professionals to screen identified cases and initiate treatment of such conditions in the primary health care setting.We retrieved the relevant literature from PubMed, Medline, and Embase using keywords adult, pregnancy, female, children, adolescent, thyroxine, thyrotropin, TSH, thyroid function test, prevalence, risk factors, hypothyroidism, cardiovascular system, lipids, sub-clinical, primary health care, community.