| given the definition of this condition, it is not surprising that the beneficial effects of L-T4 treatment in patients with subclinical hypothyroidism remain controversial. Even in patients in whom a daily 25-50 µg L-T4 dose had significantly modified TSH and free T4 concentrations, the alteration of the peripheral indices of thyroid hormone action remained questionable. Two relatively small but rigorous studies of short duration conclude, however, to an improvement of either psychometric tests and symptom rating or systolic ejection time. The main question concerns the role of subclinical hypothyroidism as a cardio-vascular risk. Whether L-T4 treatment is beneficial in this context awaits large controlled studies of long duration. In the meantime, decision to treat is mainly dependent on the physician's bias as well as the level of TSH. |
