In Reply

Latent Hypothyroidism in Adults by Jeannine Schübel, PD Dr. med. Joachim Feldkamp, Prof. Dr. med. Antje Bergmann, Dr. med. Wolfgang Drossard, and Dr. rer. medic. Dipl.-Soz. Karen Voigt, MPH in issue 25/2017

The development of goiter is triggered primarily by iodine deficiency. Thyroid-stimulating hormone (TSH) in itself does not stimulate the growth of thyroid cells (1). The fear that a raised concentration of TSH triggers the development of goiter is therefore unwarranted and does not justify treatment with L-thyroxine.

TSH concentrations of patients being treated with lithium should be measured at regular intervals, in order to detect the possible death of thyroid cells. Therapy with L-thyroxine should then be initiated when the TSH concentration is >10 mU/L. Individually, and on the basis of a particular constellation of symptoms, for example, an attempt at initiating treatment can be considered in TSH concentrations ≥ 10 mU/L. However, it should be borne in mind that it has not been proven that psychiatric symptoms improve as a result of treatment with L-thyroxine (2).

DOI: 10.3238/arztebl.2017.0752b

On behalf of the authors

Jeannine Schübel

Dr. rer. medic. Dipl.-Soz. Karen Voigt, MPH

Medizinische Fakultät Carl Gustav Carus
der Technischen Universität Dresden
Bereich Allgemeinmedizin/MK3

Conflict of interest statement

Dr. Voigt, Jeannine Schübel and Prof. Bergmann are authors of the German College of General Practitioners and Family Physicians (DEGAM, Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin) guideline „Erhöhter TSH-Wert in der Hausarztpraxis [Raised TSH values in general practice]“ (AWMF no. 053–046).

Jeannine Schübel receives royalties from Elsevier

References

1. Gärtner R, Dugrillon A: Vom Jodmangel zur Struma – Pathophysiologie der Jodmangelstruma. Internist 1998; 39: 566

2. Reuters VS, Almeida CdP, Teixeira PdFdS, et al.: Effects of subclinical hypothyroidism treatment on psychiatric symptoms, muscular complaints, and quality of life. Arq Bras Endocrinol Metabol 2012; 56: 128–36

3. Schübel J, Feldkamp J, Bergmann A, Drossard W, Voigt K: Latent hypothyroidism in adults. Dtsch Arztebl Int 2017; 114: 430–8