Basics

• TSH raised but T3, T4 normal
• no obvious symptoms

Significance

• Note that 10% of patients aged over 55 have a raised TSH
• risk of progressing to overt hypothyroidism is 2-5% per year (higher in men)
• risk increased by the presence of thyroid autoantibodies

Management

Not all patients require treatment. NICE Clinical Knowledge Summaries (CKS) have produced guidelines. Note that not all patients will fall within the age boundaries given and hence these are guidelines in the broader sense.

Treatment should be initiated if:

• Patient is symptomatic
• TSH is above 10
• Presence of autoantibodies
  • Check for Thyroid peroxidase antibodies
• Patient is pregnant or planning to become pregnant