Disclosing subclinical thyroid disease

PREVIEW

As noted by Drs Argueta and Whitaker in the first article of this symposium, modern “ultrasensitive” thyrotropin (TSH) assays can detect early, even subclinical, thyroid disease with a high degree of accuracy. Clearly, serum TSH testing is indicated in patients who have risk factors for or symptoms related to thyroid disease or who are taking exogenous thyroid hormone. However, other issues about testing and treatment are not as clear-cut. In this article, Dr Smallridge explains how to go about answering these and other important questions: Is subclinical thyroid disease the source of a given patient's symptoms? Even if there are no obvious symptoms, could mild thyroid disease be causing adverse consequences? Which patients should be tested? Which patients should be treated, and when?