Hipotiroidismul subclinic – când îl tratăm? | [The subclinical hypothyroidism / When we treat it?]

Abstract

Although subclinical hypothyroidism has been detected with increasing frequency in recent years, it is still causing major controversies concerning management and treatment. Because the cardiovascular system is considered a main target for the action of the thyroid hormone, we evaluated the effect of physiological, TSH-guided, L-thyroxine treatment on serum lipids and clinical symptoms in patients with subclinical hypothyroidism. A cohort of 76 patients with subclinical hypothyroidism was studied retrospectively over a mean observation period of 36 months. We assessed general well-being, serum lipids, thyroid function tests, and antibody status (ATPO). Subclinical hypothyroidism was classified as grade I (TSH 4.5-6 mUI/L-37 patients), grade II (TSH 6-12 mUI/L-25 patients), and grade III (TSH >12 mUI/L-14 patients). Substitutive treatment was commenced at a value of TSH above 6 mUI/L. The initial TSH value was a strong predictor for disease progression, as seen in 35% of patients with grade I, 50% with grade II, and 69% with grade III. An improvement in lipid concentrations could be observed (- 4.5% for total cholesterol and -8.8% for LDL). Substitutive treatment in subclinical hypothyroidism grade II and III has benefits on symptoms, lipid profiles, and cardiac function.