| Hypothyroidism used to be regarded as a simple condition to treat with adequacy of dosage of thyroid hormones being judged more on patient satisfaction than on biochemical monitoring. As a result of the development of sensitive tests of thyroid function there is now considerable controversy about the correct form and amount of replacement therapy and whether biochemical evidence of overtreatment, as judged by a suppressed serum TSH concentration, is a risk factor for the well-recognised complications of overt hyperthyroidism, namely atrial fibrillation and osteoporosis. On the other hand, a consensus appears to be forming that subclinical hypothyroidism should be viewed as the mildest form of thyroid failure and that it is wise to start thyroid hormone replacement sooner rather than later, particularly in those who are positive for antithyroid peroxidase antibodies. |
