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KMID : 1011720230160010032
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International Journal of Thyroidology
2023 Volume.16 No. 1 p.32 ~ p.50
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2023 Korean Thyroid Association Management Guidelines for Patients with Subclinical Hypothyroidism
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Chung Hyun-Kyung
Ku Eu-Jeong
Yoo Won-Sang
Kang Yea-Eun
Kim Kyeong-Jin
Kim Bo-Hyun
Kim Tae-Yong
Park Young-Joo
Ahn Chang-Ho
Yoon Jee-Hee
Lee Eun-Kyung
Lee Jong-Min
Jung Eui-Dal
Chung Jae-Hoon
Chung Yun-Jae
Kim Won-Bae
Yi Ka-Hee
Kang Ho-Cheol
Park Do-Joon
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Abstract
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Subclinical hypothyroidism (SCH), characterized by elevated serum thyroid-stimulating hormone (TSH) levels and normal free thyroxine levels, usually presents without symptoms, and is often discovered incidentally during routine blood test. The Task Force of the Korean Thyroid Association Committee of Clinical Practice Guidelines has established a guideline to evaluate and manage SCH; the guideline emphasizes the implementation of diagnostic criteria based on the TSH reference range for Koreans and focuses on the proven health benefits of levothyroxine (LT4) treatment. Based on the Korea National Health and Nutrition Examination Survey (2013-2015), serum TSH level of 6.8 mIU/L is considered the reference value for SCH. SCH can be categorized as mild (TSH 6.8-10.0 mIU/L) or severe (TSH ＞10.0 mIU/L), and patients are classified as adults (age ＜70 years) or elderly patients (age ≥70 years) depending on the health effects of LT4 treatment. An initial increase in serum TSH levels should be reassessed with a subsequent measurement, along with the thyroid peroxidase antibody test, preferably 2-3 months after the initial evaluation. Usually, LT4 treatment is not recommended for mild SCH in adults; however, treatment is necessary for severe SCH in patients with underlying coronary artery disease or heart failure and can be considered for coexisting dyslipidemia. LT4 treatment is not recommended for mild or even severe SCH in elderly patients, in general. Patients with SCH who receive LT4 treatment, the LT4 dosage should be personalized, and serum TSH levels should be monitored to ensure optimal LT4 dosage (dosage that is neither excessive nor insufficient). Patients with SCH who do not receive LT4 treatment require periodic follow-up at appropriate testing intervals determined by disease severity. The guideline also provides several educational points applicable in clinical settings.
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KEYWORD
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Subclinical hypothyroidism, Thyroid-stimulating hormone, Levothyroxine, Diagnosis, Management
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