When to treat with Levothyroxine?¹

There is controversy about the benefit of treating or not treating subclinical hypothyroidism.

The benefit of treatment may be greater in the following cases: patients with TSH > 10 μU/mL or TSH between 4.5 and 10 μU/mL in patients with hypercholesterolaemia. symptoms of depression, bradycardia or infertility, among others, women of childbearing potential and pregnant women, or when positive Ac, goitre or thyroid nodules are present.

Factors supporting the treatment of subclinical hypothyroidism

• Anti-thyroid antibodies (autoimmune thyroiditis)
• Prior thyroid surgery/treatment of prior hyperthyroidism
• Diffuse/nodular goitre or alterations in thyroid echostructure
• Hypercholesterolaemia, bradycardia, heart failure and depression, among others, may benefit from treatment. However, there is a risk of developing hyperthyroidism and that this could exacerbate cardiovascular disease.