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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.

In their randomized placebo-controlled trial, Caraccio . . . [Full Text of this Article]

Martin I. Surks, MD
msurks@westnet.com
Department of Medicine
Albert Einstein College of Medicine
Bronx, NY

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