How should we manage patients with mildly increased serum thyrotrophin concentrations

摘要: MarkP.J.VanderpumpConsultantPhysicianandHonorarySeniorLecturerinEndocrinologyandDiabetes,DepartmentofEndocrinology,RoyalFreeHampsteadNHSTrust,London,UKSummaryA mildly increased serum thyrotrophin (TSH) is usually becauseof mild thyroid failure, and the most common aetiology iniodine-replete communities chronic autoimmune thyroiditis. Itis more in women, prevalence increases withage both men women associated with presenceof antithyroid antibodies. The majority will have TSHlevels between 5–10 mIU/l, normal free thyroxine (T4) levels andrelatively few symptoms. In 2004, US evidence-based consensusguidelines concluded that there were no adverse outcomes of amildly TSH other than a risk progression toovert hypothyroidism data to justify levothyroxinetherapy. There still debate as what constitutes an increasedserum TSH, particularly older subjects. Although some sub-jects progress overt hypothyroidism, recent suggest asignificant proportion revert within referencerange without treatment. Two meta-analyses sug-gested possible cardiovascular risks may be signifi-cant younger adults. Other thyroidfailure only reversible cause left ventriculardiastolic dysfunction. No appropriately powered prospective,randomized, controlled, double-blinded interventional trial oflevothyroxine therapy for exists.However, treatment subjects who are symptomatic, pregnantor preconception, aged less 65 years withevidence heart failure appear justified.(Received 18 August 2009; returned revision 11 September2009; finally revised 19 September accepted 21 September2009)IntroductionSerum first-line diagnostic test hypo-thyroidism. Normal disease-free indi-viduals typically cited about 0AE4–4AE0mIU/l.