Puzzle in the diagnosis and treatment of subclinical hypothyroidism in the elderly

Based on laboratory tests,subclinical hypothyroidism is diagnosed and defined as an elevated serum TSH concentration with FT4 within reference range.Alterations in thyroid function are associated with aging.All available studies show that prevalence of subclinical hypothyroidism increases with aging,especially in women.However,some studies advise that serum TSH reference range for older people should be modified,because serum TSH elevates with aging.Therefore,when to and how to treat subclinical hypothyroidism in the elderly has been debating fiercely.At present,levothyroxine sodium treatment is generally recommended when TSH is raised more than 10 mIU/L.When TSH level is between the upper limit of the reference range and 10 mIU/L,treatment should depend on symptoms,history and risk factors of cardiovascular disease.Therapeutic objective should be individualized,depending on age,cardiac function,and other conditions. Key words: Elderly;  Subclinical hypothyroidism ;  Diagnosis ;  Treatment