The quality of the literature concerning each aspect of the statement was graded as high (randomised controlled trial (RCT) evidence - level 1) moderate (intervention short of RCT or large observational studies - level 2), or low quality (case series, case reports, expert opinion - level 3) using modified GRADE criteria. For recommendations, the GRADE system is employed which has recently been applied to other guidelines issued by the ETA and American Thyroid Association, this therefore enables alignment of part of the recommendations with those of other guidelines. The guidelines were constructed based on the best scientific evidence and the skills of the Task Force, and where available data derived from randomised clinical trials rather than from observational studies has been selected. For our Medline search, we entered in various combinations the terms thyrotropin (TSH), L-thyroxine, SCH, goitre, replacement therapy, CV risk, heart, dyslipidaemia, diabetes, obesity, mental health, quality of life, drugs. A list of all pertinent topics related to SCH was created and the members proceeded to a complete review of the literature, carrying out a systematic PubMed and Medline search for original and review articles published from 1970 through March 2013. The Task Force had no commercial support and the members declared no conflict of interest. The Executive Committee of the ETA and the Guideline Board nominated a Task Force for the development of guidelines on the management of SCH. Once patients with SCH are commenced on L-thyroxine treatment, then serum TSH should be monitored at least annually thereafter. The aim for most adults should be to reach a stable serum TSH in the lower half of the reference range (0.4-2.5 mU/l). The serum TSH should be re-checked 2 months after starting L-thyroxine therapy, and dosage adjustments made accordingly. If the decision is to treat SCH, then oral L-thyroxine, administered daily, is the treatment of choice. In younger SCH patients (serum TSH 80-85 years) with elevated serum TSH ≤10 mU/l should be carefully followed with a wait-and-see strategy, generally avoiding hormonal treatment. Even in the absence of symptoms, replacement therapy with L-thyroxine is recommended for younger patients (10 mU/l. An initially raised serum TSH, with FT 4 within reference range, should be investigated with a repeat measurement of both serum TSH and FT 4, along with thyroid peroxidase antibodies, preferably after a 2- to 3-month interval. For additional information visit Linking to and Using Content from MedlinePlus.Subclinical hypothyroidism (SCH) should be considered in two categories according to the elevation in serum thyroid-stimulating hormone (TSH) level: mildly increased TSH levels (4.0-10.0 mU/l) and more severely increased TSH value (>10 mU/l). Any duplication or distribution of the information contained herein is strictly prohibited without authorization. Links to other sites are provided for information only - they do not constitute endorsements of those other sites. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. This site complies with the HONcode standard for trustworthy health information: verify here. Learn more about A.D.A.M.'s editorial policy editorial process and privacy policy. is among the first to achieve this important distinction for online health information and services. follows rigorous standards of quality and accountability. is accredited by URAC, for Health Content Provider (URAC's accreditation program is an independent audit to verify that A.D.A.M.
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