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March 2, 2005

Subclinical Thyroid Disease and Cardiovascular Disease—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(9):1059-1060. doi:10.1001/jama.293.9.1060-a

In Reply: Dr Caraccio and colleagues1 raise important issues concerning risks of cardiovascular disease in subclinical hypothyroidism. Although a strong case can be made for recommending levothyroxine treatment for patients with serum TSH levels of more than 10 mIU/L, data supporting cardiovascular benefits of treatment when TSH level is minimally increased (>4.5 to ≤10 mIU/L) are weak and conflicting. The latter group constitutes about 80% of patients with subclinical hypothyroidism, representing millions of mainly older people, many of whom already have heart disease or have risk factors for heart disease. Studies of subclinical hypothyroidism are challenging because the magnitude of change and response to treatment of different parameters would likely be small and difficult to distinguish from controls. Also, large numbers of patients with serum TSH levels between 4.5 and 10 mIU/L are hard to find and maintain during lengthy treatment with levothyroxine.

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