Subclinical hypothyroidism - when to treat or not

[diogenes]

A new paper has emerged entitled

Clinical debate: subclinical hypothyroidism

Jasim S, Abdi H, Gharib H, Biondi B. A

Int J Endocrinol Metab. 2021;19(3):e115948. doi: 10.5812/ijem.115948.

In this is a debate about treatment or not in two cases discussed in detail. It's interesting that it shows up the logic or lack of it in reaching a decision in this difficult situation. It still however categorises patient groups via statistical TSH ranges i.e. subclinical has a range of about 5-9 TSH. It still falls into the error of thinking one can so neatly box a patient into a TSH-based decision process. But it's worth a read to see how decisions are made in this field.

[helvella]

Here's a link: sites.kowsarpub.com/ijem/ar...

[userotc in reply to helvella]

Personally I think something is missing (after a speed read). Clearly "treat" refers to allopathic treatment eg levo. But I believe that a decision not to treat SCH that way yet should include a referral to a naturopathic practitioner for non-allopathic treatment. At that stage, it is possible that the patient may not progress beyond SCH. It's a pity there is no relationship between both treatment types probably because of the arrogance of allopathic practitioners.

I certainly agree TSH should not be the sole determinant but it's level for the above referral should be nearer 2.5.

[vocalEK]

I find this maddening: " The treatment goal is to normalize TSH level."

How about a treatment goal of causing the patient to feel well again? Oh, wait! Can't have that! Must make the doctor feel good because the lab report pleases him.

[helvella in reply to vocalEK]

I couldn't agree more.

Were we to agree that a normalized TSH is some sort of an indication or way of determining good treatment (and I am 100% we don't believe that!), surely the goal absolutely has to be wellness of the person?

[Gcart in reply to helvella]

I saw a GP recently , his request about another routine matter .

TSH came up in the consult, I stood my ground but sadly I felt he made his mind up that I was a ignorant women rather than engaging in a discussion as to why I reported I was well as a result .

Nothing learnt as usual !

[jgelliss in reply to helvella]

So well said 👏. Thank you.

[Tythrop in reply to helvella]

..and what happens if the tsh has been downregulated by the body due to an illness ? here tsh monitoring is of no value, t3 is the one to watch surely?

[helvella in reply to Tythrop]

That is what I meant by "(and I am 100% we don't believe that!)" - it was just a hypothetical.

But T3 also can change due to other illnesses. Which makes it a problem.

[Tythrop in reply to helvella]

Noted with thanks

[DippyDame in reply to vocalEK]

Well said!

[jgelliss in reply to vocalEK]

Kudos for you. I couldn't agree with you more.

[penny]

My immediate reaction to the headline post is to say treat the patient if they are feeling unwell whether ‘subclinical’ or not. So, yes, I agree with previous posts.