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5 Î Due to the low risks of levothyroxine replacement therapy in children with subclinical hypothyroidism, many clinicians still consider it reasonable to initiate treatment to avoid any potential risk of negative impact on growth and development. Treatment is generally not recommended when the TSH is 5-10 mIU/L. For patients with subclinical hypothyroidism and TSH >10 mIU/L with signs and symptoms consistent with primary thyroid disease and/or risk factors associated with progression, levothyroxine replacement may be reasonable. (W-L) Secondary Hypothyroidism Î In patients with secondary hypothyroidism, the primary biochemical treatment goal should be to maintain the serum free thyroxine values in the upper half of the reference range. However, the serum free thyroxine target level may be reduced in older patients or patients with comorbidities, who may be at higher risk of complications from thyroid hormone excess. (S-M) Î Although it may be helpful to follow changes in clinical parameters in patients treated for secondary hypothyroidism, such parameters alone lack sensitivity and specificity. There is a limited amount of evidence suggesting that clinical parameters are helpful as a secondary means of judging adequacy of replacement with levothyroxine in patients with secondary hypothyroidism in whom biochemical assessment is limited to serum free thyroxine levels. (W-M) Î In patients with secondary hypothyroidism in whom the only available biochemical thyroid parameters are thyroid hormone levels, tissue markers of thyroid hormone action may be used, in addition to thyroid hormone parameters, as an adjunctive means of judging the adequacy of levothyroxine replacement. (W-L) Levothyroxine in Euthyroid Individuals Î The ATA strongly recommends against the use of levothyroxine treatment in patients who have nonspecific symptoms and normal biochemical indices of thyroid function because no role exists for use of levothyroxine in this situation. (S-H) Î The ATA recommends against the routine use of levothyroxine for the treatment of euthyroid individuals with depression due to a paucity of controlled data examining treatment efficacy in this setting. (W-L) Î The ATA recommends against the treatment of obesity with levothyroxine in euthyroid individuals due to a lack of treatment efficacy for this condition (S-M)

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