Hipotireoidismo subclínico em idosos: Tratar ou não tratar?

Hipotireoidismo subclínico em idosos: Tratar ou não tratar?

Treatment with levothyroxine provides no symptomatic benefit in older adults with subclinical hypothyroidism

Subclinical hypothyroidism is defined biochemically as an elevated serum thyroid-stimulating hormone (TSH) and a normal serum-free thyroxine (T4) level. Some patients with subclinical hypothyroidism may have vague, nonspecific symptoms. Although virtually all experts recommend treatment of subclinical hypothyroidism when serum TSH concentrations are ≥10 mU/L, treatment of patients with TSH values between the upper reference limit and 9.9 mU/L remains controversial, particularly in older patients who are more likely to have complications from unintended overtreatment. In a randomized trial evaluating the effect of levothyroxine versus placebo on quality of life measures in over 700 older patients (mean age 74.4 years) with mean TSH 6.4 mU/L, there was no difference in hypothyroid symptoms or tiredness scores after one year [2]. We do not routinely treat older patients with TSH between the upper reference limit and 9.9 mU/L (algorithm 1).

See 'Subclinical hypothyroidism in nonpregnant adults', section on 'Hypothyroid signs and symptoms'.

2. Stott DJ, Rodondi N, Kearney PM, et al. Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. N Engl J Med 2017.