Subclinical Hypothyroidism: Management in Primary Care - To treat or not to treat?

Subclinical hypothyroidism (SCH) is a relatively common condition. and it increases with age. A proportion of SCH patients will go on to develop overt hypothyroidism. Furthermore, there is concern that SCH increases the likelihood of extra thyroidal illness, such as cardiovascular disease. The diagnosis of SCH is a biochemical one, and given the common use of blood tests where thyroid function may be one component, the primary care clinician needs to understand what to do when a patient appears to have SCH. There are a variety of guidelines about the management of SCH for non-pregnant adults. The clinician needs to be aware that certain conditions can cause transient aberrations of thyroid blood test, and of those with persistent SCH, which patients might benefit from treatment and which would be better served with observation over time.