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Thyroid - Subclinical Hypothyroidism

​TSH testing, treatment evidence and repeat testing

Overdiagnosis concern

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Evidence for treating subclinical hypothyroidism where TSH is below 10 mIU/L is weak, with multiple RCTs failing to show benefit for quality of life, symptoms or cardiovascular outcomes. Up to 62% of patients with a mildly elevated TSH will have a normal result on repeat testing. Overtreatment carries documented harms including atrial fibrillation and bone loss.

Resources​

BMJ Rapid Recommendation: Thyroid treatment for SCH (2019)​

Recommends against routine levothyroxine in subclinical hypothyroidism. Freely accessible.

MDPI: To Treat or Not to Treat SCH (2020​

Systematic review of treatment evidence including effects on weight, quality of life and cardiovascular disease. Open access.

CMAJ: Screening for thyroid dysfunction (2019)

​Discusses harms of widespread TSH screening and rationale against population screening.

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