6/21/2023 0 Comments Hypothyroidism up to dateThe former, milder condition constitutes around 90% of SCH cases on a population level. SCH is generally classified in two categories according to serum TSH level: mildly increased TSH levels (4.0-10.0 mU/l) and more severely increased serum TSH concentrations (>10.0 mU/l). SCH is also more frequent in individuals of white Caucasian origin and in iodine-sufficient regions. The population prevalence of SCH amounts to approximately 5-10%, being more frequent in women and with increasing prevalence with advancing age. Strong recommendations are clinically important best practice and will be applied to most patients in most circumstances, whereas weak statements should be considered by the clinician and will be applicable best practice only to certain patients or in certain circumstances (fig. The strength of each statement was classified as strong (S - a recommendation) or weak (W - a suggestion), depending upon the clinical significance and weight of opinion favouring the statement. The quality of the literature concerning each aspect of the statement was graded as high (randomised controlled trial (RCT) evidence - level 1) moderate (intervention short of RCT or large observational studies - level 2), or low quality (case series, case reports, expert opinion - level 3) using modified GRADE criteria. For recommendations, the GRADE system is employed which has recently been applied to other guidelines issued by the ETA and American Thyroid Association, this therefore enables alignment of part of the recommendations with those of other guidelines. The guidelines were constructed based on the best scientific evidence and the skills of the Task Force, and where available data derived from randomised clinical trials rather than from observational studies has been selected. For our Medline search, we entered in various combinations the terms thyrotropin (TSH), L-thyroxine, SCH, goitre, replacement therapy, CV risk, heart, dyslipidaemia, diabetes, obesity, mental health, quality of life, drugs. A list of all pertinent topics related to SCH was created and the members proceeded to a complete review of the literature, carrying out a systematic PubMed and Medline search for original and review articles published from 1970 through March 2013. The Task Force had no commercial support and the members declared no conflict of interest. The Executive Committee of the ETA and the Guideline Board nominated a Task Force for the development of guidelines on the management of SCH. Once patients with SCH are commenced on L-thyroxine treatment, then serum TSH should be monitored at least annually thereafter. 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). The serum TSH should be re-checked 2 months after starting L-thyroxine therapy, and dosage adjustments made accordingly. If the decision is to treat SCH, then oral L-thyroxine, administered daily, is the treatment of choice. In younger SCH patients (serum TSH 80-85 years) with elevated serum TSH ≤10 mU/l should be carefully followed with a wait-and-see strategy, generally avoiding hormonal treatment. Even in the absence of symptoms, replacement therapy with L-thyroxine is recommended for younger patients (10 mU/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. Subclinical hypothyroidism (SCH) should be considered in two categories according to the elevation in serum thyroid-stimulating hormone (TSH) level: mildly increased TSH levels (4.0-10.0 mU/l) and more severely increased TSH value (>10 mU/l).
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