Thyroid substitution could prevent progression to overt hypothyroidism, improve neuropsychiatric symptoms and somatic symptoms, mood disorders, cognitive dysfunction, atypical responses to standard psychiatric therapeutic interventions, and minimize deleterious effects on cardiovascular function and lipid levels…Until better data are available, clinical judgment and patients’ preferences remain the best manner to decide.


Subclinical hypothyroidism is a condition where some laboratory findings point at a thyroid gland not working properly. Patients with subclinical hypothyroidism may have vague, non‐specific symptoms of actual hypothyroidism (for example dry skin, cold skin or feeling colder, constipation, slower thinking, poor memory) but these thyroid‐related symptoms are not specific, that is why the diagnosis is based on test results. The fundamental question regarding people with subclinical hypothyroidism is whether they should be treated with thyroid hormones. To answer this question twelve studies of six to 14 months duration involving 350 people were analysed. Thyroid hormone therapy for subclinical hypothyroidism did not result in improved survival or decreased cardiovascular morbidity (for example less heart attacks or strokes). Data on health‐related quality of life and symptoms did not demonstrate significant differences between placebo and thyroid hormone therapy. Some evidence indicated that thyroid hormone had some effects on blood lipids and technical measurements of heart function. Adverse effects were inadequately addressed in most of the included studies and have to be urgently investigated in future studies, especially in older patients.