Editing Hypothyroidism (section)

===Subclinical hypothyroidism===
There is no evidence of a benefit from treating subclinical hypothyroidism in those who are not pregnant, and there are potential risks of [[Unnecessary health care|unnecessary overtreatment]].<ref name=BMJ2019>{{cite journal |last1=Bekkering |first1=G E |last2=Agoritsas |first2=T |last3=Lytvyn |first3=L |last4=Heen |first4=A F |last5=Feller |first5=M |last6=Moutzouri |first6=E |last7=Abdulazeem |first7=H |last8=Aertgeerts |first8=B |last9=Beecher |first9=D |last10=Brito |first10=J P |last11=Farhoumand |first11=P D |last12=Singh Ospina |first12=N |last13=Rodondi |first13=N |last14=van Driel |first14=M |last15=Wallace |first15=E |last16=Snel |first16=M |last17=Okwen |first17=P M |last18=Siemieniuk |first18=R |last19=Vandvik |first19=P O |last20=Kuijpers |first20=T |last21=Vermandere |first21=M |title=Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline |journal=BMJ |volume=365 |date=14 May 2019 |pages=l2006 |doi=10.1136/bmj.l2006|pmid=31088853 |doi-access=free }}</ref> Untreated subclinical hypothyroidism may be associated with a modest increase in the risk of [[coronary artery disease]] when the TSH is over 10&nbsp;mIU/L.<ref name=BMJ2019/><ref>{{cite journal | vauthors = Ochs N, Auer R, Bauer DC, Nanchen D, Gussekloo J, Cornuz J, Rodondi N | title = Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality | journal = Annals of Internal Medicine | volume = 148 | issue = 11 | pages = 832–45 | date = June 2008 | pmid = 18490668 | doi = 10.7326/0003-4819-148-11-200806030-00225 | type = Meta-analysis | doi-access = free }}</ref> There may be an increased risk for cardiovascular death.<ref>{{cite journal |last1=Müller |first1=P |last2=Leow |first2=MK |last3=Dietrich |first3=JW |title=Minor perturbations of thyroid homeostasis and major cardiovascular endpoints-Physiological mechanisms and clinical evidence. |journal=Frontiers in Cardiovascular Medicine |date=2022 |volume=9 |pages=942971 |doi=10.3389/fcvm.2022.942971 |pmid=36046184|pmc=9420854 |doi-access=free }}</ref> A 2007 review found no benefit of thyroid hormone replacement except for "some parameters of lipid profiles and left ventricular function".<ref name="pmid17636722">{{cite journal | vauthors = Villar HC, Saconato H, Valente O, Atallah AN | title = Thyroid hormone replacement for subclinical hypothyroidism | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD003419 | date = July 2007 | volume = 2009 | pmid = 17636722 | doi = 10.1002/14651858.CD003419.pub2 | pmc = 6610974 }}</ref> There is no association between subclinical hypothyroidism and an increased risk of [[bone fracture]]s,<ref>{{cite journal | vauthors = Blum MR, Bauer DC, Collet TH, Fink HA, Cappola AR, da Costa BR, Wirth CD, Peeters RP, Åsvold BO, den Elzen WP, Luben RN, Imaizumi M, Bremner AP, Gogakos A, Eastell R, Kearney PM, Strotmeyer ES, Wallace ER, Hoff M, Ceresini G, Rivadeneira F, Uitterlinden AG, Stott DJ, Westendorp RG, Khaw KT, Langhammer A, Ferrucci L, Gussekloo J, Williams GR, Walsh JP, Jüni P, Aujesky D, Rodondi N | title = Subclinical thyroid dysfunction and fracture risk: a meta-analysis | journal = JAMA | volume = 313 | issue = 20 | pages = 2055–65 | date = May 2015 | pmid = 26010634 | pmc = 4729304 | doi = 10.1001/jama.2015.5161 }}</ref> nor is there a link with cognitive decline.<ref>{{cite journal | vauthors = Rieben C, Segna D, da Costa BR, Collet TH, Chaker L, Aubert CE, Baumgartner C, Almeida OP, Hogervorst E, Trompet S, Masaki K, Mooijaart SP, Gussekloo J, Peeters RP, Bauer DC, Aujesky D, Rodondi N | title = Subclinical Thyroid Dysfunction and the Risk of Cognitive Decline: a Meta-Analysis of Prospective Cohort Studies | journal = The Journal of Clinical Endocrinology and Metabolism | volume = 101 | issue = 12 | pages = 4945–4954 | date = December 2016 | pmid = 27689250 | pmc = 6287525 | doi = 10.1210/jc.2016-2129 }}</ref>

American guidelines recommend that treatment should be considered in people with symptoms of hypothyroidism, detectable antibodies against thyroid peroxidase, a history of heart disease, or are at an increased risk for heart disease if the TSH is elevated but below 10&nbsp;mIU/L.<ref name=Garber/> American guidelines further recommend universal treatment (independent of risk factors) in those with TSH levels that are markedly elevated; above 10 mIU/L because of an increased risk of heart failure or death due to cardiovascular disease.<ref name="Garber" /><ref name="Peters 2017" />  NICE recommends that those with a TSH above 10&nbsp;mIU/L should be treated in the same way as overt hypothyroidism. Those with an elevated TSH but below 10&nbsp;mIU/L who have symptoms suggestive of hypothyroidism should have a trial of treatment but intend to stop this if the symptoms persist despite normalization of the TSH.<ref name=NICENG145/>