22
Table 11. Subclinical Hyperthyroidism: When to Treat
Factor TSH (<0.1 mU/L) TSH (0.1–0.4 mU/L
a
Age > 65 Yes Consider treating
Age < 65 with comorbidities
Heart disease Yes Consider treating
Osteoporosis Yes Consider treating
Menopausal, not on estrogens or
bisphosphonates
Yes Consider treating
Hyperthyroid symptoms Yes Consider treating
Age < 65, asymptomatic Consider treating Observe
a
Where 0.4 mU/L is the lower limit of the normal range.
Subclinical Hyperthyroidism and Pregnancy
Subclinical Hyperthyroidism (SH)
83. When TSH is persistently <0.1 mU/L, treatment of SH is
recommended in all individuals ≥65 years of age; in patients with
cardiac risk factors, heart disease or osteoporosis; in postmenopausal
women who are not on estrogens or bisphosphonates; and in
individuals with hyperthyroid symptoms. (S-M)
84. When TSH is persistently <0.1 mU/L, treatment of SH should be
considered in asymptomatic individuals <65 years of age without
the risk factors listed above. (W-M)
85. When TSH is persistently below the lower limit of normal but
≥0.1 mU/L, treatment of SH should be considered in individuals
≥65 years of age and in patients with cardiac disease, osteoporosis,
or symptoms of hyperthyroidism. (W-M)
86. When TSH is persistently below the lower limit of normal but
≥0.1 mU/L, asymptomatic patients under age 65 without
cardiac disease or osteoporosis can be observed without further
investigation of the etiology of the subnormal TSH or treatment.
(W-L)
87. If SH is to be treated, the treatment should be based on the
etiology of the thyroid dysfunction and follow the same principles
as outlined for the treatment of overt hyperthyroidism. (S-L)
