Almost 4 decades ago, Bastenie and colleagues2 used
the term subclinical hypothyroidism to describe,
for the first time, a group of clinically euthyroid individuals with circulating
antithyroid antibodies, low normal plasma protein–bound iodine levels,
and, using a mouse bioassay, elevated serum thyrotropin levels. Evered and
colleagues3 subsequently described a similar
group of asymptomatic individuals in whom “conventional tests of thyroid
function showed nothing abnormal . . . but they were all
found to have a raised serum thyrotropin concentration.” They also used
subclinical hypothyroidism to describe this constellation of clinical and
laboratory data. Since then, hundreds of articles have been published on this
topic, but physicians are no closer to understanding whether this mild, usually
asymptomatic form of hypothyroidism presents a clinical risk, requiring screening
for detection and thyroid hormone treatment, or whether screening and therapy
are unnecessary and possibly even counterproductive.4
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