When is treatment for subclinical hypothyroidism recommended?

Treatment for subclinical hypothyroidism is recommended when the Thyroid Stimulating Hormone (TSH) level is higher than 10 mIU/L. This guideline is based on clinical evidence indicating that a TSH level above this threshold is associated with a higher likelihood of developing overt hypothyroidism and may also correlate with potential cardiovascular risks and other health issues.

In patients with TSH levels exceeding 10, the benefits of initiating treatment, such as normalizing thyroid hormone levels and potentially alleviating symptoms and risks associated with high TSH, outweigh the risks of treatment. The American Thyroid Association recommends starting levothyroxine therapy in these situations to prevent complications related to untreated hypothyroidism.

While patients displaying symptoms of hypothyroidism may warrant treatment consideration, symptom presence is not the sole deciding factor for initiating therapy, especially if TSH levels are significantly elevated. Similarly, a TSH between 5 and 10 typically does not necessitate treatment unless symptomatic or if there's specific risk for progression to overt hypothyroidism. If thyroid hormone levels are low, that might indicate overt rather than subclinical hypothyroidism, thus making treatment considerations different.