The interest in this paper is two-fold. First, the very fact that it is a Russian paper. We see all too few of these (against a torrent from China and the USA). Second, the high levels of subclinical hypothyroidism (so-called!) in Russia.
Obviously we do not know how this compares against historical levels (that is, pre-recognition of thyroid issues - meaningfully around 1890). Without knowing that it is difficult to make comparisons and to understand whether this has always been the case or has only been really prevalent in the past century or so.
As pretty much always, it ends up with "requires further study". 
Klin Lab Diagn. 2018;63(9):538-542. doi: 10.18821/0869-2084-2018-63-9-538-542.
[Methodological aspects of interpretation of thyroid-stimulating hormone reference intervals in the Northwest region megapolis hospital.]
[Article in Russian]
Volkova AR1, Dygun OD1, Katysheva NS1, Bondarenko VL1, Maltseva MN1, Belyakova LA1, Emanuel VL1.
Author information
1 FSBEI HE «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of Russian Federation, 197022, Saint Petersburg, Russia.
Abstract
The prevalence of subclinical hypothyroidism (SH) is large and according to various studies is from 3 to 21%. In the Russian Federation to date, there are no major epidemiological studies assessing the functional state of the thyroid gland. It seems relevant to study the TSH level in patients who turned to the clinical units of a large hospital in the North-West region to determine the prevalence of thyroid dysfunction in patients of different sex and age. 5,303 patients were examined, who applied to the I.P. Pavlov SPbSMU clinics for 2017. In all patients the level of TSH and free T4 was determined. SH was considered to increase the level of TSH more than 4.0 mIU/l at a normal level of free T4. Patients were divided into groups by age and TSH level in accordance with existing recommendations. Among the examined patients were 29.26% of men and 70.73% of women. The mean age was 55.08 ± 17.07 years. The TSH level had an abnormal distribution and averaged 2.77 mIU/l (TSH median 1.73 mIU/l). In women the level of TSH was significantly higher in all studied groups of patients (p = 0.0001). Among women, significant differences in the level of TSH between the elderly and young patients (p = 0.015) were found. The incidence of SH in the total group of patients was 10.1%. In the men surveyed, the incidence of SH was 7.3%, and in the female group - 11.3%. In the elderly patients, the incidence of subclinical hypothyroidism in women was 2 times higher than that of men. In most cases (77.4%) in patients with SH, the TSH level was in the range of 4.0-6.9 mIU / L. The clinical significance of minimal thyroid insufficiency requires further study.
KEYWORDS:
subclinical hypothyroidism; thyroid gland; thyroid-stimulating hormone
PMID: 30735318
DOI: 10.18821/0869-2084-2018-63-9-538-542
This encapsulates the basic logical problem of diagnosis and treatment
