Consider the Risk of Goiter
The authors deserve thanks for discussing the treatment indication for latent hypothyroidism. However, I am surprised at their recommendation to treat latent hypothyroidism only if the concentration of thyroid-stimulating hormone (TSH) is >10 mU/L. What about the risk of goiter? The authors explicitly say that patients with subclinical hypothyroidism do not require thyroid ultrasound unless one or more palpable nodules are present. As a psychiatrist I have been confronted with this problem on numerous occasions when prescribing lithium. To date, I have always recommended taking low-dose L-thyroxine when TSH concentrations are elevated, in order to avoid goiter. Should I be more cautious in this particular setting?
Dr. med. Dirk Schmoll
Psychiatrische Abteilung, Schlosspark-Klinik, Berlin
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Schübel J, Feldkamp J, Bergmann A, Drossard W, Voigt K: Latent hypothyroidism in adults. Dtsch Arztebl Int 2017; 114: 430–8 VOLLTEXT|