2013 ETA Guideline: Management of subclinical hypothyroidism
Geplaatst: vr 27 dec 2013, 14:50Volledig PDF-artikel
© 2013 European Thyroid Association
European Thyroid Journal
Published by S. Karger AG, Basel
Received: September 26, 2013
Accepted: October 7, 2013
Published online: November 27, 2013
2013 ETA Guideline: Management of Subclinical Hypothyroidism
a Institute of Genetic Medicine, Newcastle University,
and b Royal Victoria Infirmary, Newcastle upon Tyne , UK;
c Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck , Germany;
d Endocrine Unit, Evgenidion Hospital, University of Athens, Athens , Greece;
e Department of Clinical and Experimental Medicine, Università di Pisa, Pisa , Italy;
f Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus Medical Center, Rotterdam , The Netherlands;
g Queen Elizabeth Hospital, Gateshead , UK; h Clinique Endocrinologique Marc Linquette, CHU, Lille , France
Abstract
Subclinical hypothyroidism (SCH) should be considered in two categories according to the elevation in serum thyroidstimulating
hormone (TSH) level:
mildly increased TSH levels (4.0–10.0 mU/l) and more severely increased TSH value (>10mU/l).
An initially raised serum TSH, with FT 4 within reference range, should be investigated with a repeat measurement
of both serum TSH and FT 4 , along with thyroid peroxidase antibodies, preferably after a 2- to 3-month interval.
Even in the absence of symptoms, replacement therapy with L -thyroxine is recommended for younger patients (<65–70 years)
with serum TSH >10 mU/l.
In younger SCH patients (serum TSH <10 mU/l) with symptoms suggestive of hypothyroidism, a trial of L -thyroxine replacement therapy should be considered.
For such patients who have been started on L -thyroxine for symptoms attributed to SCH, response to treatment should be reviewed 3 or 4 months after a serum TSH within reference range is reached.
If there is no improvement in symptoms, L -thyroxine therapy should generally be stopped.
Age-specific local reference ranges for serum TSH should be considered in order to establish a diagnosis of SCH in older people.
The oldest old subjects (>80–85 years) with elevated serum TSH ≤ 10 mU/l should be carefully followed with a wait-and-see strategy,
generally avoiding hormonal treatment.
If the decision is to treat SCH, then oral L -thyroxine, administered daily, is the treatment of choice.
The serum TSH should be re-checked 2 months after starting L -thyroxine therapy, and dosage adjustments made accordingly.
The aim for most adults should be to reach a stable serum TSH in the lower half of the reference range (0.4–2.5 mU/l).
Once patients with SCH are commenced on L -thyroxine treatment, then serum TSH should be monitored at least annually thereafter.
Fig. 1. Suggested management algorithm.
Initial management of persistent subclinical hypothyroidism in non-pregnant adults: persistent subclinical hypothyroidism
describes patients with elevated serum TSH and within reference range serum FT 4 on two occasions separated by at least 3
months. This algorithm is meant as a guide and clinicians are expected to use their discretion and judgement in interpreting the
age threshold around 70 years. * Depending on circumstances, individuals with goitre, dyslipidaemia, and diabetes may also
be considered for treatment, along with those with planning pregnancy in the near future
Volledig:
http://www.eurothyroid.com/_downloads/2 ... oidism.pdf
© 2013 European Thyroid Association
European Thyroid Journal
Published by S. Karger AG, Basel
Received: September 26, 2013
Accepted: October 7, 2013
Published online: November 27, 2013
2013 ETA Guideline: Management of Subclinical Hypothyroidism
a Institute of Genetic Medicine, Newcastle University,
and b Royal Victoria Infirmary, Newcastle upon Tyne , UK;
c Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Lübeck , Germany;
d Endocrine Unit, Evgenidion Hospital, University of Athens, Athens , Greece;
e Department of Clinical and Experimental Medicine, Università di Pisa, Pisa , Italy;
f Rotterdam Thyroid Center, Department of Internal Medicine, Erasmus Medical Center, Rotterdam , The Netherlands;
g Queen Elizabeth Hospital, Gateshead , UK; h Clinique Endocrinologique Marc Linquette, CHU, Lille , France
Abstract
Subclinical hypothyroidism (SCH) should be considered in two categories according to the elevation in serum thyroidstimulating
hormone (TSH) level:
mildly increased TSH levels (4.0–10.0 mU/l) and more severely increased TSH value (>10mU/l).
An initially raised serum TSH, with FT 4 within reference range, should be investigated with a repeat measurement
of both serum TSH and FT 4 , along with thyroid peroxidase antibodies, preferably after a 2- to 3-month interval.
Even in the absence of symptoms, replacement therapy with L -thyroxine is recommended for younger patients (<65–70 years)
with serum TSH >10 mU/l.
In younger SCH patients (serum TSH <10 mU/l) with symptoms suggestive of hypothyroidism, a trial of L -thyroxine replacement therapy should be considered.
For such patients who have been started on L -thyroxine for symptoms attributed to SCH, response to treatment should be reviewed 3 or 4 months after a serum TSH within reference range is reached.
If there is no improvement in symptoms, L -thyroxine therapy should generally be stopped.
Age-specific local reference ranges for serum TSH should be considered in order to establish a diagnosis of SCH in older people.
The oldest old subjects (>80–85 years) with elevated serum TSH ≤ 10 mU/l should be carefully followed with a wait-and-see strategy,
generally avoiding hormonal treatment.
If the decision is to treat SCH, then oral L -thyroxine, administered daily, is the treatment of choice.
The serum TSH should be re-checked 2 months after starting L -thyroxine therapy, and dosage adjustments made accordingly.
The aim for most adults should be to reach a stable serum TSH in the lower half of the reference range (0.4–2.5 mU/l).
Once patients with SCH are commenced on L -thyroxine treatment, then serum TSH should be monitored at least annually thereafter.
Fig. 1. Suggested management algorithm.
Initial management of persistent subclinical hypothyroidism in non-pregnant adults: persistent subclinical hypothyroidism
describes patients with elevated serum TSH and within reference range serum FT 4 on two occasions separated by at least 3
months. This algorithm is meant as a guide and clinicians are expected to use their discretion and judgement in interpreting the
age threshold around 70 years. * Depending on circumstances, individuals with goitre, dyslipidaemia, and diabetes may also
be considered for treatment, along with those with planning pregnancy in the near future
Volledig:
http://www.eurothyroid.com/_downloads/2 ... oidism.pdf