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Its very sensitivity, however, may create a dilemma, since some patients are found to have elevated serum TSH levels, suggesting hypothyroidism, but have normal levels of thyroid hormone, whether measured as free thyroxine (T level—is referred to as subclinical hypothyroidism.The term “subclinical” may not be strictly correct, since some of these patients may have clinical symptoms, but no better term has been proposed.The high prevalence of thyroid failure and the difficulty of making an early clinical diagnosis in older persons suggest that screening for hypothyroidism might be useful in this group, especially since a simple test, the serum TSH level, is available.
Although the condition may resolve or remain unchanged, within a few years in some patients, overt hypothyroidism develops, with low free T levels as well as a raised TSH level.
The third possibility, progression to overt hypothyroidism, occurs at a rate of about 5 percent per year in patients with raised TSH levels and detectable antithyroid antibodies.8 In selected cases (e.g., elderly patients with high titers of antithyroid antibodies), the risk of progression to overt disease may be closer to 20 percent per year.9 Consideration of these possible outcomes affects the decision about whether to treat or to observe without treatment. But even in the earliest (subclinical stage), one or more of these findings may occur.