The Thyroid – too much and too little across the ages. The consequences of subclinical thyroid dysfunction

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Summary: Mild thyroid dysfunction is common, and more prevalent than overt hyper‐ and hypothyroidism. Subclinical (mild) thyroid dysfunction is a biochemical entity characterized by an abnormality of serum TSH associated with normal serum thyroid hormone concentrations. Subclinical hyperthyroidism is thus defined as low or suppressed serum TSH with normal serum‐free T4 and T3, while subclinical hypothyroidism is defined as raised serum TSH with normal circulating T4. These biochemical abnormalities are part of the much wider spectrum of thyroid dysfunction which includes overt hyperthyroidism and overt hypothyroidism, but by no means always indicate underlying thyroid disease. There is much debate about the significance of mild abnormalities of thyroid function in terms of symptoms and potential associations with long‐term morbidity and mortality and hence much debate about whether to screen for these abnormalities, and, once identified, whether to treat or monitor, and if so, how? Our knowledge base has increased significantly in recent years, principally because studies of large cohorts have begun to define the epidemiology and associations of mild thyroid dysfunction (including short‐term and long‐term outcomes) and a small but increasing number of randomized‐controlled intervention studies have been reported. There is, however, much to learn about these disorders and, given their prevalence, their impact on health.

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